[Tolerance to nitrates in patients with angina and effect of plasmapheresis].

AIM: To evaluate tolerance to isosorbide dinitrate (ID) in patients with angina pectoris functional class II-III and effect of plasmapheresis in this tolerance management.

MATERIAL AND

METHODS

85 patients with angina pectoris functional class II-III taking long-acting ID.

RESULTS

As shown by repeat transesophageal left atrial pacing, 24.7% patients have developed tolerance to nitrate while taking prolonged ID. Two methods of this tolerance elimination were compared: plasmapheresis + withdrawal of long-acting nitrate and withdrawal of the nitrates only. The former has shown some advantages: use of plasmapheresis reestablished ID efficiency in 4 days (two sessions) in 81.8% and in 7 days (3 sessions) in 100% patients without withdrawal syndrome. The latter method reestablished a marked antiischemic effect of ID in 7 days and 20% patients exhibited a variant of withdrawal syndrome--early negative aftereffect.

CONCLUSION

When withdrawal of long-acting nitrates is combined with plasmapheresis in anginal patients to eliminate tolerance to nitrates, the effect is better.