How do nitrates treat heart disease?

Nitrates are medications used to prevent, reduce, or relieve angina. Nitrates work by relaxing the muscular walls of arteries and veins and reducing the blood pressure that the heart must pump against.
Anthony L. Komaroff, MD
Internal Medicine
Nitrates have been used for more than a century to treat angina. They work by dilating arteries and veins in the heart and elsewhere in the body. This reduces stress on the heart muscle which, in turn, reduces the amount of oxygen the heart requires. This lets the heart function longer without developing ischemia, even when blood flow through the coronary arteries is partially blocked by atherosclerosis. Nitrates can be used two ways. They can be taken to help stop angina once chest pain appears. They can also be taken to help prevent angina from occurring.

One common form, nitroglycerin (Nitrostat), is best known as the little white pills that people carry with them and slip under the tongue when they have bouts of chest pain. The drug also comes in different forms, including a short-acting liquid spray as well as long-acting ointments and patches. People who take the long-acting forms run the risk of developing nitrate tolerance, which means the body no longer responds to the drug's effects. Removing the patch at night can minimize this risk.

Other nitrate delivery systems, including long-acting isosorbide mononitrates (Imdur, Ismo), accomplish the same thing with a single dose each day. One risk with this approach is that you might be left unprotected during the first hour or so after awakening -- a high-risk time for heart attacks. This problem is often addressed by using other long-acting anti-anginal medications in conjunction with the nitrates.
Nitrates are medications that relieve chest pain (angina) by dilating the blood vessel allowing more blood to flow.  In patients with narrowed arteries of the heart nitrates can dilate the vessel allowing more blood flow and reducing symptoms of angina (chest pain).. Patients who have had previous heart attacks or angina may be prescribed nitrates.

Examples of Nitrates:
isosorbide dinitrate (Dilatrate-SR, Isordil)
isosorbide mononitrate (ISMO)
nitroglycerin (Nitro-Dur, Nitrolingual, Nitrostat, and others)

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