Does Tolerance Develop During Long-Acting Nitrate Therapy? A Critical Review

Nitroglycerin and long-acting nitrate esters are playing an increasingly wide role in medicine. These agents are effective in the treatment of a variety of cardiovascular conditions (Table 1) and are the mainstay of therapy in the medical treatment of angina pectoris. Many patients with moderately severe congestive heart failure benefit from nitrates, with reductions in left-ventricular filling pressures and maintained or increased cardiac output. During the past 5–7 years it has been shown convincingly that high-dose nitrate therapy is often necessary, particularly in heart failure or refractory angina. Many patients are now receiving nitrates in amounts that formerly would have been considered excessive, but are actually necessary to provide adequate bioavailability and sustained pharmacological activity (1, 2).