Nitrate tolerance. State of the art--chairman's summary.

The development of tolerance to the effects of nitrates is well documented in the literature. It can be induced and rapidly reversed with all types of nitrates and it is more pronounced in the arterial as compared to the venous circulation. Cross-tolerance between different nitrates exists. Furthermore, tolerance seems more related to high and continuous plasma concentrations and may possibly be avoided by intermittent dosing. The importance of such factors as patient selection, type of nitrate preparation, duration of therapy, the significance of target organs, methods of evaluating the development of nitrate tolerance as well as a summary of the discussions during the workshop is presented.