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The antianginal effect was associated with a decrease of 14 mmHg in systolic arterial pressure and an increase of 3 beats/min in heart rate. Diastolic arterial pressure was not altered. This is a most important safety factor in patients with coronary artery disease, in whom reduction in coronary arterial pressure is deleterious. Raffienbeul et al  compared the effects of nifedipine, administered intravenously at a rate of 15-30 mg124 h, and nitroglycerin, administered intravenously at a rate of 30-60 mg124 h, over a 72-h observation period in 20 patients with angina pectoris at rest.
Parker and coworkers have consistently reported that the antianginal effect of nitrates was abolished during continued treatment of up to 2 weeks [114, 115]. The most recent studies from this group, however, used long-acting formulations of nitrates, namely transdermal nitroglycerin disks and ISDN ointment, which might have special problems. The possibility of tolerance to transdermally administered nitrates is discussed separately in the chapter on this topic. Studies on Long-Term Use of Nitrates in Angina Pectoris 39 long-term use of new nitrate formulations will clarify this point.
In contrast, patients receiving nitroglycerin required progressively higher doses. The most common adverse effect was hypotension - in 14% of the patients on nitroglycerin and 8% on ISDN. 2. Effect on Size and Complications of Acute Myocardial Infarction The anti-ischemic effects of nitrates can result in a decrease in infarct size. This has been demonstrated in experimental and clinical studies, using pathologic, enzymatic and electrocardiographic evaluation ofinfarct size [130-137]. In many of these studies it was shown that maintenance of adequate coronary perfusion pressure is essential for the beneficial effect.