Headache response to nitrate in patients with coronary artery disease and systolic heart failure

Efficacy and Safety of Suxiao Jiuxin Pills in the Treatment of Chronic Coronary Syndrome with Intolerance to Adverse Effects of Long-acting Nitrates: A Multicenter, Randomized, Double-blind, Placebo-controlled Study

BACKGROUND

This study aims to investigate the short-term effects and safety of adjunct Suxiao Jiuxin Pills (SJPs) on conventional therapy in chronic coronary syndrome (CCS) patients who are intolerant to the adverse effects of long-acting nitrates.

METHODS

This was a multicenter, randomized, double-blind, placebo-controlled trial. A total of 174 CCS participants from eight clinical study centers in China were included in the modified intention-to-treat analyses. Participants with CCS and intolerance to the adverse effects of long-acting nitrates were recruited and randomized to either the SJPs or the placebo group for a duration of 4 weeks.

RESULTS

Compared to the placebo group, the SJPs group showed a significant improvement in the efficacy rate after 4 weeks (OR = 2.43, 95% CI = 1.32 to 4.47, P = 0.004). Besides, individuals without a history of alcohol consumption showed a greater improvement in the SAQ summary score compared to those with a history of alcohol consumption.

CONCLUSION

Adjunctive SJPs enhance the effectiveness of short-term conventional anti-angina treatment for patients with CCS who experience intolerance to long-acting nitrates, without significant adverse effects during application.

TRIAL REGISTRATION

Chinese Clinical Trials Registry Platform, ChiCTR2100050066. Registered 16 August 2021, https://www.chictr.org.cn/showproj.html?proj=131470 .

The effect of local cold compresses for nitroglycerin-induced headache: An observational pretest-posttest study

BACKGROUND

Nitroglycerin (NTG)-induced headache is the most common side effect of nitrate therapy and negatively affects the quality of life.

AIMS

To assess the preventive and severity-reducing effect of cold compresses applied to the bilateral frontotemporal and occipital regions, where pain is most frequently experienced, for headache among individuals receiving intravenous NTG treatment.

STUDY DESIGN

This research used an observational, two-group, pretest-posttest design and was completed from October 2020 to May 2021 in the coronary intensive care unit of a state hospital located in the north of Turkey. The first group in the research had cold compresses applied for 20 min with the aid of an applicator at the start of NTG infusion, while the second group had the same implementation when headache developed during infusion.

RESULTS

Both groups were similar in terms of the demographic and clinical features of participants. In our study, more headache was observed in the group without local cold compresses at the start of infusion (53.3%) compared with the group with local cold compresses at the start of infusion (25.8%) (χ2  = 4.841, p = .028). In both groups, the heart rate, systolic and diastolic blood pressure values of patients significantly approached normal values after cold compresses. Patients with local cold compresses applied when headache developed had significantly different visual analog scale scores before (5.75) and after (2.00) the cold compresses application (z = 3.558, p = .000).

CONCLUSION

At the beginning of the infusion, local cold compresses application may prevent NTG-induced headache in patients without headache, and local cold compresses applied when headache develops may reduce the severity of NTG-induced headache.

RELEVANCE TO CLINICAL PRACTICE

Application of cold compresses immediately when treatment begins is recommended as a simple and effective practice with no side effects for patients receiving NTG treatment.

Relationship between Nitrate-Induced Headache and Coronary Artery Lesion Complexity

OBJECTIVE

The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD).

SUBJECTS AND METHODS

Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system.

RESULTS

The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore.

CONCLUSION

The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.