Nitrates and nitrate tolerance in angina pectoris

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This work explores various aspects of pharmacology, hemodynamics, and coronary heart disease related to nitrate therapy. The first section examines tolerance from pharmacokinetic and pharmacodynamic perspectives, critically reviewing whether tolerance develops during long-acting nitrate therapy and investigating the pharmacokinetics of isosorbide dinitrate during this process. The second section focuses on hemodynamic effects, highlighting the lack of tolerance development in patients with chronic congestive heart failure and the effects of 5-isosorbide mononitrate during both acute and chronic administration. It also discusses methods to demonstrate nitrate tolerance in peripheral vessels and compares the effects of various vasodilators on congestive heart failure. The impact of long-term isosorbide dinitrate therapy for pulmonary hypertension in patients with chronic obstructive lung disease is analyzed, along with the development of tolerance and peripheral hemodynamic effects of molsidomine. The final section addresses coronary heart disease, detailing the acute and chronic effects of oral isosorbide dinitrate in angina patients and evaluating tolerance in those undergoing chronic treatment. It also assesses the long-term effects of high-dose therapy and investigates cross-tolerance between oral isosorbide dinitrate and sublingual nitroglycerin through exercise testing. Additionally, the effects of long-acting nitrates on