Evidence supporting the use of: Nitrate
For the health condition: Chest Pain

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Synopsis

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

Nitrates, such as nitroglycerin, are scientifically validated treatments for chest pain (angina pectoris). Their use is rooted in robust clinical evidence and has been a mainstay in cardiology for over a century. Nitrates work by relaxing vascular smooth muscle, leading to vasodilation, primarily of veins but also of arteries at higher doses. This venodilation reduces venous return (preload) to the heart, lowering myocardial oxygen demand. Additionally, nitrates dilate coronary arteries, improving blood flow to ischemic myocardial tissue. Multiple randomized controlled trials and meta-analyses have established nitrates as effective in relieving angina symptoms and preventing angina attacks. Sublingual nitroglycerin is widely used for rapid relief of acute chest pain, while long-acting nitrate formulations are used for chronic prophylaxis. Guidelines from major cardiovascular societies such as the American Heart Association (AHA) and European Society of Cardiology (ESC) recommend nitrates as first-line symptomatic therapy for angina. However, it is important to note that while nitrates relieve symptoms, they do not reduce mortality or prevent myocardial infarction. Their role is primarily symptomatic control. Tolerance can develop with continuous use, so dosing regimens with nitrate-free intervals are recommended. In summary, the use of nitrates for chest pain is strongly supported by extensive scientific evidence and clinical practice guidelines, making them a cornerstone in the management of angina pectoris.

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