What question did this study set out to answer?

Determine the minimal effective dose and duration of hemodynamic action of transdermal nitroglycerin patches in patients with congestive heart failure.

May 1, 1985CirculationOpen Access

Dose requirements and hemodynamic effects of transdermal nitroglycerin compared with placebo in patients with congestive heart failure.

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Why the study?

Does transdermal nitroglycerin improve hemodynamics in patients with congestive heart failure?

Population

23 patients with chronic heart failure

Comparison

Transdermal nitroglycerin 60 mg/24 hr as a… vs Placebo as a single application

Design

RCT, random, double-blind

Follow-up

24 hours

Authors

RJR A JordanArkansas Department of Agriculture LSL SeithVoith (United States)DHDoreen Henry

Discussion

Member takes

Implication

High-dose transdermal nitroglycerin acutely lowers filling pressures in HF; extends evidence of rapid nitrate tolerance.

Key Points

Determine the minimal effective dose and duration of hemodynamic action of transdermal nitroglycerin patches in patients with congestive heart failure.
Conducted an initial dose-titration phase in 8 patients with chronic heart failure to determine the minimal effective dose producing at least a 30% reduction in pulmonary capillary wedge pressure.
Conducted a randomized double-blind trial in 15 patients with heart failure receiving a single application of 60 mg/24 hr transdermal nitroglycerin (n=8) or placebo (n=7) with hemodynamic monitoring for 24 hours.
Transdermal nitroglycerin significantly reduced baseline pulmonary capillary wedge pressure of 22 ± 7 mm Hg by 6 ± 6 mm Hg at 2 hours (p < .05), reaching a peak reduction of 8 ± 6 mm Hg at 4 hours (p < .01).
Reductions in wedge pressure, pulmonary arterial pressure, right atrial pressure, and pulmonary vascular resistance remained significant through 12 hours but were no longer significant by 18 hours, while placebo induced no significant changes.

Structured PICO

Does transdermal nitroglycerin improve hemodynamics in patients with congestive heart failure?

Population

23 patients with chronic heart failure (8 in an initial dose-finding phase, 15 in a randomized double-blind phase)

Intervention

Transdermal nitroglycerin 60 mg/24 hr (120 cm2) as a single application

Comparator

Placebo as a single application

Outcome

Change in pulmonary capillary wedge pressure monitored for up to 24 hourssurrogate

Transdermal nitroglycerin is an effective vasodilator in heart failure but requires a high dose (at least 60 mg/24 hr) and its hemodynamic effects do not persist beyond 18 hours, suggesting rapid development of tolerance.

Cite This Study

Jordan et al. (1985) studied this question.

synapsesocial.com/papers/6a72a02a2fdcb5703edb95d0 https://doi.org/10.1161/01.cir.71.5.980

Topics

HFrEF treatment Heart failure

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Dose requirements and hemodynamic effects of transdermal nitroglycerin compared with placebo in patients with congestive heart failure.

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Dose requirements and hemodynamic effects of transdermal nitroglycerin compared with placebo in patients with congestive heart failure.

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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