Long-Term Use of Nitrates in Angina Pectoris

Several investigators have suggested that long-term treatment with nitrates in patients with angina pectoris is associated with development of tolerance. Although this theory is in contrast to the clinical experience of most cardiologists, it is supported by some evidence. In this chapter the subject is reviewed, with the conclusion that tolerance to the antianginal effect does not develop or can be reduced if the drugs are appropriately used. The topic is subdivided into three main areas: 1. vascular tolerance 2. tolerance to the antianginal effect 3. cross tolerance