Does sublingual nitroglycerin reduce left ventricular afterload more than what is apparent from brachial artery pressure measurements in patients undergoing cardiac catheterization?
Nitroglycerin reduces left ventricular afterload through arterial dilation more significantly than what is reflected by peripheral (brachial) artery pressure measurements.
Nitroglycerin (0.3 mg) was administered sublingually to 14 patients undergoing cardiac catheterization, and pressure waves compared in the ascending aorta and brachial artery. After nitroglycerin, ascending aortic systolic pressure fell in all cases (by 6-44, average 22 mmHg) whereas brachial systolic pressure remained unchanged (in three) or fell to a lesser degree (4-33, average 12 mmHg). Diastolic pressure did not change significantly. Alterations in pressure and in wave contour were explained on the basis of arterial dilation, with reduction in wave reflection. Nitroglycerin reduces left ventricular afterload through arterial dilation as well as preload through venous dilation. This effect on afterload is not apparent from measurement of pressure in the brachial artery.
Kelly et al. (Thu,) studied this question.