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Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery
Abstract
Nitroglycerin (0.3 mg) was administered sublingually to 14 patients undergoing cardiac catheterization, and pressure waves compared in the ascending aorta and brachial artery. After nitroglycerin, ascending aortic systolic pressure fell in all cases (by 6-44, average 22 mmHg) whereas brachial systolic pressure remained unchanged (in three) or fell to a lesser degree (4-33, average 12 mmHg). Diastolic pressure did not change significantly. Alterations in pressure and in wave contour were explained on the basis of arterial dilation, with reduction in wave reflection. Nitroglycerin reduces left ventricular afterload through arterial dilation as well as preload through venous dilation. This effect on afterload is not apparent from measurement of pressure in the brachial artery.
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“the organic nitrates (e.g. glycerol trinitrate-GTN) releasing nitric oxide in the systemic circulation, reducing left ventricular filling pressure and increasing cardiac index suggesting improvement in cardiac performance (Franciosa et al. 1978) through decreasing both preload and afterload (Kelly et al. 1990).”
From Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure (2016) · cites this paper as Kelly et al. 1990
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Lakatta, E. G. (1994) · Comprehensive physiology · doi:10.1002/j.2040-4603.1994.tb01689.x
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Pitsavos, C. S., Stefanadis, C., & TOUTOUZAS, P. K. (1999) · Developments in cardiovascular medicine · doi:10.1007/978-1-4615-5007-5_13
Vallée, F. (2019) · theses.fr (ABES) · doi:10.70675/a84f8a72z4142z4b67zafe4z1fe83f7e10cd
Gerdanovics, C.-A., Alexescu, T., Login, C., Orasan, O. H., Tiperciuc, B., Tomoiagă, A.-V., Ciulei, G., Milea, P.-A., Măgureanu, D. C., Hiceag, L. M., et al. (2026) · Diagnostics · doi:10.3390/diagnostics16203273
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Jiang, X., & O’Rourke, M. F. (2014) · Springer eBooks · doi:10.1007/978-1-4471-5198-2_42
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Metadata
- Authors
- KELLY, R. P., GIBS, H. H., O'ROURKE, M. F., DALEY, J. E., MANG, K., MORGEN, J. J., & AVOLID, A. P.
- Affiliations
- UNSW Sydney (AU)
- ORCID
- KELLY, R. P.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 1990-02
- Volume
- 11
- Issue
- 2
- Pages
- 138-144
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W1927450934
- Cited by
- 312
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 9 · 2021: 8 · 2020: 9 · 2019: 10 · 2018: 7 · 2017: 11 · 2016: 15 · 2015: 5 · 2014: 17 · 2013: 10 · 2012: 16
- FWCI
- 5.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- nitroglycerin, left ventricular afterload, arterial dilatation, wave reflection, aortic pressure, sublingual administration, venous dilation, preload
- MeSH terms
- Administration, Sublingual, Adult, Aged, Aorta, Blood Pressure, Blood Pressure Determination, Female, Nitroglycerin, Cardiac Catheterization, Heart Ventricles, Humans, Male, Middle Aged, Vasodilation
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