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Evidence summaries

Nitrates in Unstable Angina

There is insufficient evidence on the effect of nitrates in the prevention of death or myocardial infarction in patients with unstable angina. However, nitrates are effective in pain relief and remain the first-line treatment together with heparin and aspirin in unstable angina. Level of evidence: "D"

A topic in Clinical Evidence 1 summarizes the evidence on the effects of nitrates in unstable angina. No systematic reviews or RCTS of nitrates versus placebo with long-term outcomes in unstable angina were found. One RCT compared intravenous nitroglycerin with placebo for 48 hours in 162 patients with unstable angina. Those receiving nitroglycerin had fewer episodes of chest pain, less severe episodes (pain lasting > 20 minutes) and less need for additional sublingual nitroglycerin.

There is evidence that nitrates are safe and well tolerated when used cautiously at clinically appropriate doses.

The authors conclude that no good evidence exists that nitrates prevent death or myocardial infarction in patients with unstable angina. Yet, by consensus, until further data are available, intravenous nitrates remain the first-line treatment together with heparin and aspirin in unstable angina.

    References

    • Natarajan M. Nitrates in unstable angina. Clinical Evidence 2000;4:159-160.

Primary/Secondary Keywords