Nitrates and Nitrate Tolerance in Angina Pectoris

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This book covers various aspects of pharmacology and hemodynamics related to nitrate therapy, particularly focusing on tolerance development. It begins with an exploration of tolerance from both pharmacokinetic and pharmacodynamic perspectives, critically reviewing whether tolerance occurs during long-acting nitrate therapy. The pharmacokinetics of isosorbide dinitrate during tolerance development is examined, alongside the hemodynamic effects of 5-isosorbide mononitrate during both acute and chronic administration. The text discusses the lack of tolerance development to the hemodynamic effects of nitrates in patients with chronic congestive heart failure and presents investigations aimed at demonstrating nitrate tolerance in peripheral vessels through simple hemodynamic tests. Further sections delve into the treatment of congestive heart failure with vasodilators, comparing the acute and long-term effects of various agents, and the long-term use of isosorbide dinitrate for pulmonary hypertension in patients with chronic obstructive lung disease. The book also addresses coronary heart disease, detailing the acute and chronic effects of oral isosorbide dinitrate in patients with angina, and evaluating cross-tolerance between long-term oral isosorbide dinitrate and sublingual nitroglycerin. Additionally, it assesses the impact of long-acting nitrates on ambulatory ECG changes in angina pectoris patients and the chronic treatmen