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Nitratbehandlung

Nitrate treatment

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Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Organische Nitrate werden zur Behandlung der stabilen Angina-Pectoris-Symptomatik, des akuten Koronarsyndroms und bei der akuten und chronischen Herzinsuffizienz eingesetzt. Trotz der nachweislich guten Wirkung bei der Akutgabe der organischen Nitrate ist die Langzeittherapie durch eine Toleranzentwicklung limitiert. Neuere tierexperimentelle, aber auch klinische Daten belegen, dass zusätzlich eine endotheliale Dysfunktion induziert wird, ein Punkt, der bedenklich stimmt, insbesondere unter dem Aspekt, dass eine endotheliale Dysfunktion eine negative prognostische Bedeutung besitzt. Aufgrund dieser Nebenwirkungen wurde in der Leitlinien der American Heart Association [1] und der American College of Physicians [2] empfohlen, bei der Behandlung der stabilen Angina Pectoris auf den Einsatz von Langzeitnitraten wie Mono- und Dinitrate zu verzichten und stattdessen bei gleichzeitig noch guter linksventrikulärer Funktion eher den Kalziumantagonisten Amlodipin zu verwenden [1]. Bei deutlich eingeschränkter linksventrikulärer Funktion wird aufgrund der kürzlich publizierten A-HEFT-Studie diskutiert, inwieweit eine Kombinationstherapie, bestehend aus organischen Nitraten und dem arteriolär wirksamen Dilatator Hydralazin, bei allen Patienten mit schwerer Herzinsuffizienz sinnvoll ist.

Abstract

Organic nitrates are used for the treatment of angina pectoris symptoms, acute coronary syndrome and for acute and chronic heart insufficiency. In spite of the proven effectiveness of organic nitrates for acute cases, long-term therapy is limited by to the development of tolerance. Recent animal experiments, as well as clinical data, show that an endothelial dysfunction is also induced, a disquieting point, especially considering the negative prognostic impact of endothelial dysfunction. Due to these side effects, the published guidelines of the American Heart Association and the American College of Physicians do not recommend the use of long-term nitrates, such as mono- and dinitrate, for the treatment of stable angina pectoris. Rather, if good left ventricular function is present the calcium antagonist amlodipine should be used. In cases of appreciably reduced left ventricular function, there is a current discussion, based on the recently published A-HeFT study, as to whether a combination therapy with organic nitrates and the effective arteriole dilator hydralazine is beneficial for patients with severe heart insufficiency.

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Durchführung vorklinischer und klinischer Studien für ACTAVIS, Produkt PETN. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. II. Medizinische Klinik und Poliklinik, Klinikum der Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz, Deutschland

    T. Münzel & F. Post

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  1. T. Münzel
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  2. F. Post
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Correspondence to T. Münzel.

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Münzel, T., Post, F. Nitratbehandlung. Clin Res Cardiol Suppl 2, 31–42 (2007). https://doi.org/10.1007/s11789-006-0022-0

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