Synopsis

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

Nitrates, such as nitroglycerin and isosorbide dinitrate, are well-established medications for the treatment and prevention of chest pain (angina pectoris) associated with coronary artery disease. Their primary mechanism of action is the relaxation of vascular smooth muscle, leading to vasodilation. This vasodilation decreases venous return (preload) and, to a lesser extent, arterial resistance (afterload), thereby reducing myocardial oxygen demand. Additionally, nitrates can dilate coronary arteries, which may improve blood flow to ischemic heart tissue. The clinical efficacy of nitrates in relieving angina has been demonstrated in numerous randomized controlled trials and meta-analyses over several decades. The use of sublingual nitroglycerin as an acute treatment for angina attacks is standard in emergency and outpatient settings, and long-acting nitrate preparations are commonly used for chronic prophylaxis. Guidelines from major cardiology societies (such as the American Heart Association and European Society of Cardiology) recommend nitrates as a first-line therapy for symptomatic relief of angina. The extensive body of scientific evidence supporting the use of nitrates for chest pain makes their use highly validated, justifying a top evidence score.

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