Evidence supporting the use of: Nitrates
For the health condition: Angina

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Synopsis

Source of validity: Scientific
Rating (out of 5): 5

Nitrates, such as nitroglycerin, are scientifically validated treatments for angina pectoris. Angina is chest pain caused by reduced blood flow to the heart muscle, typically due to coronary artery disease. Nitrates work by relaxing vascular smooth muscle, leading to vasodilation—primarily of the veins and, to a lesser extent, coronary arteries. This reduces preload (venous return to the heart) and myocardial oxygen demand, thereby alleviating anginal symptoms. Additionally, nitrates can improve oxygen delivery to ischemic myocardial tissue by dilating coronary arteries.

The use of nitrates for angina has a long-standing history, with nitroglycerin first introduced into clinical practice in the late 19th century. Numerous clinical trials and decades of clinical use have demonstrated their efficacy in both the acute relief and prevention of angina episodes. Guidelines from major cardiology societies, such as the American College of Cardiology and the European Society of Cardiology, recommend nitrates as first-line therapy for the symptomatic management of angina.

While nitrates do not address the underlying atherosclerotic disease, their role in symptom relief is well established and grounded in both pathophysiological rationale and robust clinical evidence. They are available in various formulations (sublingual, oral, transdermal, intravenous) to suit different clinical scenarios. However, tolerance with chronic use and contraindications (such as concurrent phosphodiesterase inhibitor use) must be considered.

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