Mertens H M, Ohlmeier H, Mannebach H, Kabelitz K, Gleichmann U
Herz. 1985 Jun;10(3):172-81.
Thirty-two hospitalized patients with angiographically-documented coronary artery disease and stable angina pectoris (NYHA class III) were randomly assigned to one of four treatment groups. After a one-week washout period, baseline examinations (systolic time intervals, blood pressure and exercise ECG) were performed. The patients were then treated with either 20 mg isosorbide dinitrate in sustained-release form (sustained-release ISDN), 20 mg isosorbide 5-mononitrate (IS 5-MN), 2.5 mg buccal nitroglycerin in sustained-release form (NTGB) or 6.5 mg oral nitroglycerin in sustained-release form (NTGO) and one hour thereafter, the heart rate, blood pressure and systolic time intervals were determined. Subsequently, the patients were treated with the respective nitrates four times daily for two weeks. On the seventh and 14th days, the heart rate, blood pressure and systolic time intervals were again determined before and after the first dose of the day. Additionally, after the first dose on the 14th day, an exercise ECG was performed. The effect of the nitrates on the venous capacitance system is reflected by the increase in the PEP/LVET ratio where NTGO and NTGB elicited marked actions and those of sustained-release ISDN and IS 5-MN were of a lesser extent. An effect on systolic and diastolic blood pressure at rest and during exercise could be documented only after administration of NTGB. The anti-ischemic effect of the nitrates was based on the reduction of ST-segment depression during exercise; after two weeks of treatment, sustained-release ISDN and IS 5-MN were associated with complete tolerance development while NTGO continued to exert a slight, and NTGB a clear reduction in ST-segment depression. Personal protocols documented that nitrate consumption and rate of anginal attacks during longterm treatment were unaffected by sustained-release ISDN, IS 5-MN and NTGO, but were reduced by 50% while on treatment with NTGB.
32例经血管造影证实患有冠状动脉疾病且心绞痛稳定（纽约心脏协会III级）的住院患者被随机分配到四个治疗组之一。在为期一周的洗脱期后，进行基线检查（收缩期时间间期、血压和运动心电图）。然后患者接受以下治疗之一：20毫克缓释二硝酸异山梨酯（缓释ISDN）、20毫克5-单硝酸异山梨酯（IS 5-MN）、2.5毫克缓释颊下硝酸甘油（NTGB）或6.5毫克缓释口服硝酸甘油（NTGO），一小时后测定心率、血压和收缩期时间间期。随后，患者每天接受四次相应的硝酸盐治疗，持续两周。在第7天和第14天，在当天第一剂给药前后再次测定心率、血压和收缩期时间间期。此外，在第14天第一剂给药后，进行运动心电图检查。硝酸盐对静脉容量系统的作用通过PEP/LVET比值的增加反映出来，其中NTGO和NTGB引起明显作用，而缓释ISDN和IS 5-MN的作用程度较小。仅在给予NTGB后，可证明对静息和运动时的收缩压和舒张压有影响。硝酸盐的抗缺血作用基于运动时ST段压低的降低；治疗两周后，缓释ISDN和IS 5-MN出现完全耐受性，而NTGO继续产生轻微作用，NTGB则使ST段压低明显降低。个人用药记录显示，长期治疗期间硝酸盐的消耗量和心绞痛发作率不受缓释ISDN、IS 5-MN和NTGO的影响，但在接受NTGB治疗时降低了50%。
