Vasodilator therapy: nitrates and nicorandil
File(s)
Published version
Author(s)
Tarkin, Jason M
Kaski, Juan Carlos
Type
Journal Article
Abstract
Nitrates have been used to treat symptoms of chronic stable angina for over 135 years. These drugs are known to activate nitric oxide (NO)-cyclic guanosine-3′,-5′-monophasphate (cGMP) signaling pathways underlying vascular smooth muscle cell relaxation, albeit many questions relating to how nitrates work at the cellular level remain unanswered. Physiologically, the anti-angina effects of nitrates are mostly due to peripheral venous dilatation leading to reduction in preload and therefore left ventricular wall stress, and, to a lesser extent, epicardial coronary artery dilatation and lowering of systemic blood pressure. By counteracting ischemic mechanisms, short-acting nitrates offer rapid relief following an angina attack. Long-acting nitrates, used commonly for angina prophylaxis are recommended second-line, after beta-blockers and calcium channel antagonists. Nicorandil is a balanced vasodilator that acts as both NO donor and arterial K+ ATP channel opener. Nicorandil might also exhibit cardioprotective properties via mitochondrial ischemic preconditioning. While nitrates and nicorandil are effective pharmacological agents for prevention of angina symptoms, when prescribing these drugs it is important to consider that unwanted and poorly tolerated hemodynamic side-effects such as headache and orthostatic hypotension can often occur owing to systemic vasodilatation. It is also necessary to ensure that a dosing regime is followed that avoids nitrate tolerance, which not only results in loss of drug efficacy, but might also cause endothelial dysfunction and increase long-term cardiovascular risk. Here we provide an update on the pharmacological management of chronic stable angina using nitrates and nicorandil.
Date Issued
2016-06-16
Date Acceptance
2016-06-01
Citation
Cardiovascular Drugs and Therapy, 2016, 30 (4), pp.367-378
ISSN
0920-3206
Publisher
Springer Verlag
Start Page
367
End Page
378
Journal / Book Title
Cardiovascular Drugs and Therapy
Volume
30
Issue
4
Copyright Statement
© The Author(s) 2016. This article is an open access publication, corrected publication August/2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000385163100005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Pharmacology & Pharmacy
Cardiovascular System & Cardiology
Nitrates
Nicorandil
Vasodilators
Stable angina
STABLE ANGINA-PECTORIS
CORONARY-ARTERY-DISEASE
ISCHEMIC-HEART-DISEASE
MITOCHONDRIAL ALDEHYDE DEHYDROGENASE
RELEASE ISOSORBIDE-MONONITRATE
SENSITIVE POTASSIUM CHANNELS
MYOCARDIAL BLOOD-FLOW
NITRIC-OXIDE SYNTHASE
LONG-TERM EFFICACY
CARDIAC SYNDROME-X
Publication Status
Published