Role of short-acting nitroglycerin in the management of ischemic heart disease.
Role of short-acting nitroglycerin in the management of ischemic heart disease.
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DOI：
10.2147/dddt.s79116
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Sidhu MS
中科院分区：
文献类型：
--
作者：
Boden WE;Padala SK;Cabral KP;Buschmann IR;Sidhu MS
硝酸甘油是最古老且最常用的短效抗心绞痛药物；然而，尽管其治疗用途历史悠久，但患者和医疗保健提供者关于短效制剂对心绞痛患者的临床益处的教育仍然没有得到充分认识。硝酸盐主要引起大容量血管的血管舒张，增加心外膜冠状动脉直径和冠状动脉侧支血流量，并损害血小板聚集。短效硝酸盐的预防作用的潜力仍然是减少心绞痛和心肌缺血从而提高生活质量的最佳药物治疗中未被充分认识的一部分。短效硝酸甘油以舌下片剂或喷雾剂的形式给药，可以补充抗心绞痛治疗，作为难治性和复发性心绞痛患者最佳药物治疗的一部分，无论是否有心肌血运重建，最常用于快速缓解急性复发性心绞痛发作。当预防性给药时，两种制剂都能增加跑步机测试中的无心绞痛步行时间，消除或延迟 ST 段压低，并提高运动耐力。与片剂制剂相比，舌下喷雾制剂具有多种临床优势，包括头痛发生率较低，在治疗作用和起效时间方面优于舌下片剂，而血管舒张作用的强度和持续时间似乎相当。此外，对于口干患者来说，舌下喷雾制剂可能比片剂制剂更有利。本综述讨论了短效硝酸甘油（舌下喷雾剂和片剂）治疗预防和中止急性心绞痛发作的功效和实用性，从而提高生活质量。
Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated. Nitrates predominantly induce vasodilation in large capacitance blood vessels, increase epicardial coronary arterial diameter and coronary collateral blood flow, and impair platelet aggregation. The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life. Short-acting nitroglycerin, administered either as a sublingual tablet or spray, can complement anti-anginal therapy as part of optimal medical therapy in patients with refractory and recurrent angina either with or without myocardial revascularization, and is most commonly used to provide rapid therapeutic relief of acute recurrent angina attacks. When administered prophylactically, both formulations increase angina-free walking time on treadmill testing, abolish or delay ST segment depression, and increase exercise tolerance. The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable. Furthermore, the sublingual spray formulation may be advantageous to tablet preparations in patients with dry mouth. This review discusses the efficacy and utility of short-acting nitroglycerin (sublingual spray and tablet) therapy for both preventing and aborting an acute angina attack, thereby leading to an improved quality of life.