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Introduction[edit | edit source]

Coronary Artery Disease

Nitrates are a class of medications that cause vasodilation. Nitrates exert their effects by dilating venous vessels, coronary arteries, and small arterioles; its maximal vasodilation is in the venous vessels.

  1. Nitrates are primarily indicated for the treatment of angina, where preferential venodilation causes pooling of blood, decreased preload, and ultimately decreased myocardial O2 demand.
  2. At high doses, nitrates can decrease afterload and may be used in hypertensive crises. The main adverse effects include headache, hypotension, and reflex tachycardia[1][2].

Indications[edit | edit source]

3 forms of Nitroglycerin: IV; sublingual spray; nitroglycerin patch.

The type of nitrates used and the administration route differs depending on the type of cardiovascular disease. The use of nitrates is indicated in the following cardiovascular diseases: angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure. The main types of nitrates are as followed:

  1. Nitroglycerin (NTG): angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension. Various administration routes: Sublingual tablet; Transdermal patch; Ointment; Capsule; Spray; or IV
  2. Isosorbide mononitrate (ISMN): chronic angina pectoris (treatment) Administration: Tablet; Sublingual tablet; or Spray
  3. Isosorbide dinitrate (ISDN): angina pectoris (treatment/prophylaxis) Administration: Tablet or Tablet (Sustained release)[1].

Types[edit | edit source]

  1. Short-acting nitrate preparations: eg Glyceryl trinitrate (GTN) tablets or sprays are commonly used to ease angina pains.
  2. Long-acting nitrate preparations: A long-acting preparation takes longer to start working, so is not much use for immediate pain relief. But, it works for much longer after each dose than a short-acting preparation (which loses its effect after 20 minutes or so).

Side Effects[edit | edit source]

Common side-effects include:

  • A throbbing headache.
  • A flushed face.
  • Dizziness.
  • Lightheadedness (from the nitrate causing low blood pressure).
  • Feeling slightly nauseous.
  • With the spray under the tongue: a slight burning or tingling sensation under the tongue[3].

Do Nitrates lower blood pressure?[edit | edit source]

Beetroot ideas

A 2015 study suggests the nitrates in many vegetables may keep blood vessels healthy and lower blood pressure. Previous studies have shown that a diet rich in fruits and vegetables, such as the Dietary Approaches to Stop HypertensionHypertension (DASH) diet, can reduce blood pressure.[4]

Foods to boost your nitric oxide levels include: Beets, rich in dietary nitrates, which your body can convert to nitric oxide; Garlic; Dark Chocolate; Leafy Greens; Citrus Fruits; Pomegranate; Nuts and Seeds[5].

Physiotherapy Relevance[edit | edit source]

Nitrates Clinical relevance when exercising

  1. For acute use; hypotension and reflex tachycardia are common Monitor HR and BP.
  2. Prophlactic treatment; Monitor symptoms of hypotension, tachycardia and angina[6]

References[edit | edit source]

  1. 1.0 1.1 Lee PM, Gerriets V. Nitrates. InStatPearls [Internet] 2021 Jul 13. StatPearls Publishing.Available: 7.4.2022)
  2. Lecturio Nitrates Available: (accessed 7.4.2022)
  3. Patient Info Nitrate medication Available; (accessed 7.4.2022)
  4. Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015 Feb;65(2):320-7. Available: (accessed 7.4.2022)
  5. Ask a lot of questions What drugs are considered nitrates? Available: (accessed 7.4.2022)
  6. Heart Online Exercise response to cardiac medications Available: (accessed 7.4.2022)