2015


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2015/№6

Experience of using different forms of long-acting nitrates considering their effects on quality of life in patients with stable angina

Kucheryavaya N. G.1, Bochkareva E. V.1, Arutyunov G. P.2, Koziolova N. A.3, Barbarash O. L.4, Boytsov S. A.1, Bylova N. A.2
1 – Federal State Budgetary Institution, “National Research Center for Preventive Medicine” of the RF Ministry of Health Care, Petroverigsky Per. 10, Bldg. 3, Moscow 101990
2 – State Budgetary Educational Institution of Higher Professional Education, “N. I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997
3 – State Budgetary Educational Institution of Higher Professional Education, “Academician E. A. Vagner Perm State Medical Academy” of the RF Ministry of Health Care, Petropavlovskaya 26, Perm 614000
4 – Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: bucccal nitroglycerin, trinitrolong, organic nitrates, stable angina, exercise tests, quality of life

DOI: 10.18087/rhj.2015.6.2133

Background. Long-acting nitrates belong to second line drugs. They are recommended for combination treatment to reduce frequency and intensity of angina attacks. In some cases, when pronounced contraindications for first-line drugs are present long-acting nitrates can be used as drugs of choice. Aim. To compare antianginal and anti-ischemic effects, tolerability and effects on quality of life (QoL) for Trinitrolong, a buccal nitroglycerin (bNTG), and the most commonly long-acting nitrate tablets, isosorbide-5-mononitrate (I5M) and isosorbide dinitrate (ID), in patients with stable exertional angina. Materials and methods. This multicenter, open, randomized, comparative study included 102 patients aged 61.5±4.3 who have had at least three angina attacks per week on the background of routine physical activity and a positive exercise test (ET) on a treadmill. After randomization, patients received bNTG 4-8 mg / day as required and I5M 50 mg / day or ID 40 mg / day in a crossover fashion for 6 weeks each. At baseline and after each study therapy, ET was performed and threshold exercise duration (Tthr) was evaluated; mean numbers per week of angina attacks and taken short-acting nitroglycerin (SAN) tablets (doses) were counted; and QoL was assessed. Results. All drugs induced a significant increase in exercise tolerance, a significant decrease in angina attack rate and SAN intake per week, and exerted a beneficial effect on QoL. As distinct from bNTG and I5M, regular ID intake was associated with development of tolerance. No considerable difference was noted between drugs in the incidence of side effects. Conclusion. Buccal NTG exerted pronounced, stable antianginal and anti-ischemic effects and showed good tolerability comparable with those of up-to-date long-acting oral forms of the organic nitrates, ID and I5M. Buccal NTG significantly improved QoL and did not induce tolerance as distinct from ID. Due to the fast effect and a possibility of using the drug immediately before expected physical activity, bNTG enhances exercise tolerance and psychological confidence in successful completion of the exercise. In the current conditions of implementing the idea of reasonable import substitution, bNTG being in the mid-price segment of domestic pharmaceutical production may become a valid alternative to foreign long-acting nitrates.
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Kucheryavaya N. G., Bochkareva E. V., Arutyunov G. P., Koziolova N. A., Barbarash O. L., Boytsov S. A. et al. Experience of using different forms of long-acting nitrates considering their effects on quality of life in patients with stable angina. Russian Heart Journal. 2015;14 (6):343–349

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