[Hemodynamic effect and duration of action of Deponit 10 in patients with congestive heart insufficiency].

The haemodynamic effect of transdermal nitroglycerin treatment with Deponit 10 was investigated in 10 patients with chronic cardiac failure due to coronary artery disease (8 patients) or congestive cardiomyopathy (2 patients). The patients had elevated mean pulmonary artery (PA) and pulmonary capillary wedge pressures (PC) at rest (32.1 +/- 5.9 and 24.1 +/- 6.6 mm Hg). Heart rate (87 +/- 10), arterial blood pressure (133 +/- 20/77 +/- 8 mm Hg) and cardiac index (3.73 +/- 0.85 l/min/m2) were in the normal range. During treatment with Deponit 10 mean PA and PC pressures decreased significantly (p less than 0.01) to 25.5 +/- 6.3 and 18.1 +/- 6.4 mm Hg, respectively. The effect was seen within 1 hour after application of the transdermal therapeutic system and reached its nadir after 2 hours. PA and PC pressures remained significantly below control for 12-16 hours. Heart rate, arterial blood pressure and cardiac index were not changed. After removal of the patch 4 patients showed a rebound haemodynamic deterioration. Their mean PA pressure rose by more than 4 mm Hg above the respective control values. These patients had the highest control PA pressures of the group studied (37.5 +/- 2.4 mm Hg). Thus, transdermal nitroglycerin treatment with Deponit 10 reduces cardiac preload in patients with congestive heart failure for 12-16 hours, whereas cardiac afterload remains unaffected. After removal of the patch a rebound phenomenon can occur especially in patients with severe cardiac failure.