Effect of cutaneous nitroglycerin patches on coronary artery diameter: issues concerning development of tolerance

Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, 08903-0019.

The coronary dilative and systemic responses to graded doses of intracoronary nitroglycerin were studied in 53 patients undergoing diagnostic coronary arteriography, 43 of whom had received a cutaneous nitroglycerin patch. During coronary arteriography, graded doses of 50, 100 and 200 micrograms of intracoronary nitroglycerin were given 5 min apart. An arteriogram and hemodynamic measurements were obtained after each dose. In the control group (n = 10) cumulative intracoronary nitroglycerin doses of 50, 150 and 350 micrograms caused an increase in coronary diameter in the left anterior descending artery of 20 +/- 4%, 21 +/- 3% and 22 +/- 7%, respectively, and in the circumflex artery of 18 +/- 6%, 23 +/- 8% and 18 +/- 5% (p less than 0.01 versus values in untreated group). In Group 1 (15 patients given a 5 mg/24 h nitroglycerin patch 2 to 12 h before coronary arteriography), the same intracoronary nitroglycerin doses increased the left anterior descending artery diameter by 6 +/- 2%, 7 +/- 2% and 7 +/- 2%, respectively, and the circumflex artery diameter by 3 +/- 2%, 3 +/- 2% and 1 +/- 3%. All values were statistically different from control (p less than 0.05). An even more pronounced blunting (p less than 0.01) of the coronary dilative response was observed in Group 2 (14 patients given a 15 mg/24 h nitroglycerin patch 2 to 12 h before arteriography).(ABSTRACT TRUNCATED AT 250 WORDS)