ABSTRACT
BACKGROUND: Nitrates are widely used in the treatment of angina in patients with acute myocardial infarction (AMI). Short-term administration prevents left ventricular (LV) dilation and infarct expansion. However, little information is available regarding their long-term effects on LV remodeling in patients surviving Q-wave AMI. METHODS AND RESULTS: This was a randomized, double-blind, placebo-controlled trial designed to investigate the long-term (6-month) efficacy of intermittent transdermal nitroglycerin (NTG) patches on LV remodeling in 291 survivors of AMI. Patients meeting entry criteria had baseline gated radionuclide angiography (RNA) followed by randomization to placebo or active NTG patches delivering 0.4-, 0.8-, or 1.6-mg/h. RNA was repeated at 6 months and 6.5 days after withdrawal of double-blind medication. The primary study end point was the change in end-systolic volume index (ESVI). Both ESVI and end-diastolic volume index (EDVI) were significantly reduced with 0.4-mg/h NTG patches (-11.4 and -11.6 mL/m2, respectively, P<.03). This beneficial effect was observed primarily in patients with a baseline LV ejection fraction < or =40% (deltaESVI, -31 mL/m2; deltaEDVI, -33 mL/m2; both P<.05) and only at the 0.4-mg/h dose. After NTG patch withdrawal, ESVI significantly increased but did not reach pretreatment values. CONCLUSIONS: Transdermal NTG patches prevent LV dilation in patients surviving AMI. The beneficial effects are limited to patients with depressed LV function and only at the lowest (0.4-mg/h) dose. Continued administration is necessary to maintain efficacy. Whether these remodeling effects confer a clinical or survival advantage will need to be addressed in an adequately powered cardiac event trial.
Subject(s)
Myocardial Infarction/drug therapy , Nitroglycerin/administration & dosage , Vasodilator Agents/administration & dosage , Ventricular Function, Left/drug effects , Administration, Cutaneous , Adult , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cardiac Volume/drug effects , Double-Blind Method , Female , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology , Prospective StudiesABSTRACT
One hundred forty-two patients with stable angina were enrolled in a four-week, multicenter, office-based study to compare the adhesion properties, patient preference, and tolerability of two commercially available transdermal nitroglycerin patches. Data from 139 patients were analyzed. Each patient simultaneously wore one 5-mg Transderm-Nitro (TDN) patch and one 5-mg Deponit (DPT) patch. Patients daily recorded the following information in a diary format: number of angina attacks, frequency of sublingual nitroglycerin use, patch adhesion, and problems at the adhesion site or other medical problems. At the end of the study, patients rated their patch preferences based on ease of application and removal, ease of removing backing, overall adhesion, and adhesion under specific conditions, such as showering, swimming, exercise, hot weather, high humidity, and perspiration. They also specified which patch they would choose for their next prescription. Differences in adhesion properties (P less than 0.0001) and tolerability at the site of application favored TDN over DPT. In addition, significantly more patients (P less than 0.0001) specified TDN as their next prescription choice (83% vs 11%).
Subject(s)
Angina Pectoris/prevention & control , Nitroglycerin/therapeutic use , Adhesiveness , Administration, Cutaneous , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multicenter Studies as Topic , Nitroglycerin/administration & dosage , Nitroglycerin/adverse effectsABSTRACT
The charts of patients initially treated with long-acting oral or ointment (LAOO) nitrate therapy who subsequently used transdermal nitroglycerin (TNG) patches for the treatment of angina pectoris were reviewed to evaluate patient response, cost-effectiveness, and therapy preference. Fewer hospital admissions and emergency room visits were required during the period of TNG therapy than during the period of LAOO therapy. In addition, more patients reported improvement in angina status during TNG therapy, and a strong patient preference was noted for TNG treatment over the other forms of therapy. The cost analysis showed a trend toward a cost advantage for TNG therapy.
Subject(s)
Nitrates/administration & dosage , Nitroglycerin/administration & dosage , Administration, Cutaneous , Administration, Oral , Adult , Aged , Aged, 80 and over , Angina Pectoris/drug therapy , Angina, Unstable/drug therapy , Delayed-Action Preparations , Female , Hospitalization/economics , Humans , Male , Middle Aged , Nitrates/adverse effects , Nitroglycerin/adverse effects , Ointments , Retrospective StudiesABSTRACT
The adhesive properties of two transdermal nitroglycerin controlled-release systems, Transderm-Nitro (TDN) and Nitro-Dur (ND), were compared in 65 patients receiving treatment for angina pectoris. Patients applied transdermal patches of both systems daily (randomized as to side of body applied) for four weeks and maintained daily diaries recording number of angina attacks, additional nitroglycerin use, patch adhesion, and skin problems. A total of 1,702 TDN and 1,692 ND patches were applied, of which six (0.4%) TDN and 83 (4.9%) ND fell off. An additional 4.8% of TDN patches and 16.2% of ND patches adhered only partially. Problems at site of application, such as itching, rash, or redness, were reported with both patches but were far more frequent with ND than with TDN. Patients preferred TDN (86.2%) over ND (9.2%).
