EFFECTS OF DIURETIC THERAPY ON THE DEVELOPMENT OF TOLERANCE DURING CONTINUOUS THERAPY WITH NITROGLYCERIN

被引:41
作者
PARKER, JD
FARRELL, B
FENTON, T
PARKER, JO
机构
[1] QUEENS UNIV, KINGSTON GEN HOSP, DEPT MED, DIV CARDIOL, KINGSTON K7L 3N6, ONTARIO, CANADA
[2] MT SINAI HOSP, DEPT MED, DIV CARDIOL, 600 UNIV AVE, TORONTO M5G 1X5, ONTARIO, CANADA
[3] HARVARD UNIV, SCH PUBL HLTH, DEPT BIOSTAT, BOSTON, MA 02115 USA
[4] BRIGHAM & WOMENS HOSP, DEPT MED, DIV CARDIOVASC, BOSTON, MA 02115 USA
关键词
D O I
10.1016/0735-1097(92)90016-G
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. This study examined the effects of concurrent diuretic therapy on the hemodynamic responses to short-term and sustained therapy with transdermal nitroglycerin. Background. Sodium retention and plasma volume expansion occur during therapy with nitroglycerin and may play a role in the loss of nitroglycerin effects during sustained therapy. Methods. Twenty-two normal male volunteers were treated for 1 week with either hydrochlorothiazide and amiloride (50 + 5 mg) (n = 11) or placebo (n = 11) in a randomized, double-blind fashion. All 22 subjects then received continuous transdermal nitroglycerin (19 +/- 1 mg/24 h) for 5 to 7 days. Results. On the first and last day of transdermal nitroglycerin therapy, standing heart rate, systolic blood pressure and hematocrit values were assessed at 8, 9 and 10 AM and 12 noon. Heart rate and blood pressure responses to sublingual nitroglycerin (0.6 mg) were also evaluated before and after sustained transdermal nitroglycerin therapy. A significant loss of the hemodynamic effects of transdermal and sublingual nitroglycerin occurred during sustained therapy in both the diuretic and placebo therapy groups. In both groups, transdermal nitroglycerin therapy was associated with a significant decrease in hematocrit that persisted for the entire treatment period. Conclusions. These results suggest that diuretic therapy does not prevent plasma volume expansion or the loss of hemodynamic effects during sustained transdermal nitroglycerin therapy. The persistent decrease in hematocrit suggests that plasma volume expansion plays a role in the attenuation of nitrate effects. It also provides evidence of continued vascular activity of nitroglycerin despite loss of systemic hemodynamic effects.
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收藏
页码:616 / 622
页数:7
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