Circulation, Vol 72, 747-752, Copyright © 1985 by American Heart Association
T Imaizumi, A Takeshita, T Ashihara and M Nakamura
This study examined the effects of sublingually administered nitroglycerin
on forearm resistance vessels in normal subjects (n = 9) and in patients
with congestive heart failure (n = 8). Forearm blood flow was measured with
a strain-gauge plethysmograph and forearm vascular resistance was
calculated. To assess the magnitude of reflex forearm vasoconstriction
triggered by decreased central venous pressure after sublingual
nitroglycerin, lower body negative pressure (LBNP) was applied to produce a
comparable decrease in central venous pressure to that after nitroglycerin.
The change in forearm vascular resistance during LBNP was compared with
that after nitroglycerin. In normal subjects, LBNP increased but
nitroglycerin did not change forearm vascular resistance. In patients with
congestive heart failure neither nitroglycerin nor LBNP changed forearm
vascular resistance. The direct vasodilator effect of nitroglycerin on
forearm resistance vessels assessed by the difference between the change in
forearm vascular resistance produced by nitroglycerin and that during LBNP
tended to be less in patients with congestive heart failure than in normal
subjects, which might have resulted from decreased vasodilator capacity of
resistance vessels in patients with congestive heart failure. Changes in
forearm vascular resistance with a cold pressor test were not different
between normal subjects and patients with congestive heart failure. These
data suggest that in normal subjects, nitroglycerin does not alter forearm
vascular resistance because its dilator effect is offset by reflex
vasoconstriction. In patients with congestive heart failure, reflex
vasoconstriction is impaired but the direct vasodilator effect of
nitroglycerin also tends to be reduced, so that as a net effect forearm
vascular resistance is not altered.
ARTICLES
The effects of sublingually administered nitroglycerin on forearm vascular resistance in patients with heart failure and in normal subjects
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