Abrams J
University of New Mexico School of Medicine, Albuquerque 87131-4356, USA.
Can J Cardiol. 1996 May;12 Suppl C:9C-16C.
Nitroglycerin and the long-acting nitrates are effective antianginal agents that have been used in clinical medicine for over 100 years. These drugs are reliable, safe, familiar to clinicians, inexpensive, and easy to use. Side effects are limited to headache and postural hypotensive symptoms. Nitrate tolerance or attenuation, -ie, loss of, or decrease in, nitrate efficacy with repeated dosing-is common and represents the major drawback to chronic therapy. Carefully designed dosing regimens and/or appropriate use of nitrate formulations (to include a nitrate-free period each day) will decrease or eliminate the problem of nitrate tolerance. In head-on comparative studies, nitrates appear to be as effective as beta-blockers or calcium channel blockers in the monotherapy of chronic angina. Ideal patient characteristics for nitrate therapy include: predictably favourable response of chest pain to sublingual nitroglycerin; angina episodes suggestive of coronary vaso-constriction or spasm; left ventricular systolic dysfunction; symptoms of congestive heart failure (systolic or diastolic dysfunction).
硝酸甘油和长效硝酸盐类药物是有效的抗心绞痛药物，已在临床医学中使用了100多年。这些药物可靠、安全，临床医生熟悉，价格低廉且易于使用。副作用仅限于头痛和体位性低血压症状。硝酸盐耐受性或药效减弱，即重复给药后硝酸盐疗效丧失或降低，很常见，是长期治疗的主要缺点。精心设计的给药方案和/或适当使用硝酸盐制剂（包括每天有一段无硝酸盐期）将减少或消除硝酸盐耐受性问题。在直接对比研究中，硝酸盐在慢性心绞痛的单一疗法中似乎与β受体阻滞剂或钙通道阻滞剂一样有效。硝酸盐治疗的理想患者特征包括：胸痛对舌下硝酸甘油有可预测的良好反应；提示冠状动脉血管收缩或痉挛的心绞痛发作；左心室收缩功能障碍；充血性心力衰竭症状（收缩或舒张功能障碍）。
