Long-Acting Nitrates in the Treatment of Angina Pectoris

"LONG-ACTING" nitrates are widely regarded as a mainstay of medical therapy for angina pectoris, but their efficacy and duration of action remain controversial. Moreover, a confusing variety of nitrate preparations is currently available (Table). Now that other effective modes of angina prophylaxis exist (for example, propranolol hydrochloride or coronary bypass surgery), a critical awareness of the usefulness and limitations of long-acting nitrates is all the more important. This review will outline nitrate pharmacology and propose a practical approach to the rational selection of an effective nitrate regimen for the individual patient. The therapeutic effectiveness of sublingual nitroglycerin in typical angina pectoris is clear-cut and undisputed. Administration of an effective dose during anginal pain clearly reduces the duration of the episode if the patient's untreated angina normally persists long enough for sublingual nitroglycerin to take effect. While this effect is helpful and reas