Nitrates in the prophylactic treatment of angina pectoris

The complexities of evaluating antianginal agents have led to much confusion regarding the various nitrate preparations. The resulting controversies are probably best resolved by appreciating very real differences in the approach employed by different investigators and by applying sound principles of pharmacology and physiology. At present, the weight of evidence suggests that most sublingual nitrates, though very effective, are not particularly long lasting with regard to symptomatic improvement. Recent exercise data, however, suggest that nitroglycerin ointment may be distinctly superior to either sublingual or oral nitrates in angina prophylaxis. The use of nitroglycerin ointment certainly deserves careful reassessment. Before pursuing this course, however, one must give serious consideration to the possibility of untoward effects, in particular the possibility of nitrate tolerance and nitrate dependence.