Nitrates in clinical practice

V.V. Nikonov, Ye.I. Kinoshenko, S.V. Kursov


In recent years, the field of application of nitrates in cardiology has undergone certain changes. The widespread use of thrombolytic drugs in acute myocardial infarction has led to a decrease in the frequency of using intravenous nitrates in this pathology, and the widespread use of angiotensin-converting enzyme inhibitors and the expansion of the indications for the administration of angiotensin II receptor antagonists (sartans) for heart failure have helped to limit the use of nitrates in the treatment of such patients. But despite new developments and approaches to the therapy of coronary heart disease, nitrates are one of the important groups of drugs. With stable angina pectoris, nitrates relieve ischemic pain, prevent the development of anginal syndrome and increase patients’ exercise tolerance. In acute coronary syndrome, nitrates stop a pain attack, prevent left ventricular remodeling after myocardial infarction, improve the state of intracardiac and systemic hemodynamics, reduce the size of the zone of myocardial infarction and decrease the incidence of hospital-acquired cardiovascular complications. Intravenous and oral administration of nitrates during and after thrombolytic therapy in patients with ST-segment elevation acute myocardial infarction shows a tendency to decrease their mortality. At the same time, the use of nitrates in patients at risk (women and elderly patients) or their combined use with angiotensin-converting enzyme inhibitors, as shown by the ISIS-4 and GISSI-3 trials, significantly reduces the mortality of patients with ST-segment ele­vation acute myocardial infarction. In patients with heart failure, nitrates significantly improve the clinical symptoms and the state of systemic hemodynamics, and when used together with hydralazine, as shown by the VHeFT-l study, they reduce their mortality. Moreover, the scope of nitrate use in modern medical practice is not limi­ted only to patients with coronary heart disease and heart failure. Nitrates are widely used in the treatment of hypertensive crises and pulmonary edema. Nitrates are often prescribed for patients with portal hypertension and pulmonary hypertension (to reduce pressure in the corresponding vascular systems). As antispasmodics, nitrates can be used to stop colic in patients with gallstone disease and urolithiasis. There are reports on the effective use of nitrates in obstetric practice (with threatened miscarriage and fetal distress), as well as in ophthalmology (with retinal thrombosis). The data presented indicate that nitrates, as before, deserve close attention and wider use in clinical practice.


nitrates; coronary heart disease; myocardial infarction; portal hypertension


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