US EPA

2245959 

Journal Article 

Review 

Nitrates for stable angina: A systematic review and meta-analysis of randomized clinical trials 

Wei, J; Wu, T; Yang, Q; Chen, Mao; Ni, J; Huang, D 

2011 

Yes 

International Journal of Cardiology
ISSN: 0167-5273
EISSN: 1874-1754 

146 

1 

4-12 

English 

20557963 

10.1016/j.ijcard.2010.05.019 

WOS:000285779700009 

Objective: To assess the effect (harms and benefits) of nitrates for stable angina. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Randomized controlled trials with both parallel and crossover design were included. The following outcome measures were evaluated: number of angina attacks weekly and nitroglycerin consumption, quality of life, total exercise duration, time to onset of angina and time to 1 mm ST depression. Results: Fifty-one trials with 3595 patients meeting inclusion criteria were analyzed. Both intermittent and continuous regimens of nitrates lengthened exercise duration significantly by 31 and 53 s respectively. The number of angina attacks was significantly reduced by 2.89 episodes weekly for continuous administration and 1.5 episodes weekly for intermittent administration. With intermittent administration, increased dose provided with 21 s more length of exercise duration. With continuous administration, exercise duration was pronged more in low-dose group. Quality of life was not improved by continuous application of GTN patches and was similar between continuous and intermittent groups. In addition, 51.6% patients receiving nitrates complained with headache. Conclusion: Long-term administration of nitrates was beneficial for angina prophylaxis and improved exercise performance but might be ineffective for improving quality of life. With continuous regimen, low-dose nitrates were more effective than high-dose ones for improving exercise performance. By contrast, with intermittent regimen, high-dose nitrates were more effective. In addition, intermittent administration could bring zero-hour effect. (C) 2010 Elsevier Ireland Ltd. All rights reserved. 

Coronary artery disease; Angina pectoris; Nitrates; Nitroglycerin; Isosorbide mononitrate; Isosorbide dinitrate; Meta-analysis; Randomized controlled trials