Efficacy and tolerability of transdermal nitroglycerin in heart failure. A noninvasive placebo controlled double-blind cross over study.

The efficacy of transdermal nitroglycerin was investigated in 18 patients with moderate to severe congestive heart failure in a placebo-controlled, double-blind, crossover study. Treatment periods were of four weeks, following a one week dose titration period during which the maximum tolerated dose within the range of 5-15 mg was estimated. Therapeutic effects were evaluated by clinical examination (NYHA class), treadmill exercise, echocardiography and patient subjective scaling of general well being, cardiac symptoms and dyspnoea. Both patient and investigator analogue scaling of general well being showed improved scores indicating an improvement throughout the study. This tendency was even more marked when comparing inclusion values with those after each treatment period (P less than 0.05). However, when comparing values before with those after each treatment period, only the investigator scaling of heart failure level proved significantly higher after the placebo period (P less than 0.05). No other findings of significance were observed. We conclude that transdermal nitroglycerin given in the present doses over four weeks fails to improve the clinical situation in patients with moderate to severe congestive heart failure.