Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/115461
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Type: Journal article
Title: Inorganic nitrate in angina study: a randomized double-blind placebo-controlled trial
Author: Schwarz, K.
Singh, S.
Parasuraman, S.
Rudd, A.
Shepstone, L.
Feelisch, M.
Minnion, M.
Ahmad, S.
Madhani, M.
Horowitz, J.
Dawson, D.
Frenneaux, M.
Citation: Journal of the American Heart Association, 2017; 6(9):006478-1-006478-S
Publisher: Wiley
Issue Date: 2017
ISSN: 2047-9980
2047-9980
Statement of
Responsibility: 
Konstantin Schwarz, Satnam Singh, Satish K. Parasuraman, Amelia Rudd, Lee Shepstone, Martin Feelisch, Magdalena Minnion, Shakil Ahmad, Melanie Madhani, John Horowitz, Dana K. Dawson, Michael P. Frenneaux
Abstract: Background: In this double-blind randomized placebo-controlled crossover trial, we investigated whether oral sodium nitrate, when added to existing background medication, reduces exertional ischemia in patients with angina. Methods and Results: Seventy patients with stable angina, positive electrocardiogram treadmill test, and either angiographic or functional test evidence of significant ischemic heart disease were randomized to receive oral treatment with either placebo or sodium nitrate (600 mg; 7 mmol) for 7 to 10 days, followed by a 2-week washout period before crossing over to the other treatment (n=34 placebo-nitrate, n=36 nitrate-placebo). At baseline and at the end of each treatment, patients underwent modified Bruce electrocardiogram treadmill test, modified Seattle Questionnaire, and subgroups were investigated with dobutamine stress, echocardiogram, and blood tests. The primary outcome was time to 1 mm ST depression on electrocardiogram treadmill test. Compared with placebo, inorganic nitrate treatment tended to increase the primary outcome exercise time to 1 mm ST segment depression (645.6 [603.1, 688.0] seconds versus 661.2 [6183, 704.0] seconds, P=0.10) and significantly increased total exercise time (744.4 [702.4, 786.4] seconds versus 760.9 [719.5, 802.2] seconds, P=0.04; mean [95% confidence interval]). Nitrate treatment robustly increased plasma nitrate (18.3 [15.2, 21.5] versus 297.6 [218.4, 376.8] μmol/L, P<0.0001) and almost doubled circulating nitrite concentrations (346 [285, 405] versus 552 [398, 706] nmol/L, P=0.003; placebo versus nitrate treatment). Other secondary outcomes were not significantly altered by the intervention. Patients on antacid medication appeared to benefit less from nitrate supplementation. Conclusions: Sodium nitrate treatment may confer a modest exercise capacity benefit in patients with chronic angina who are taking other background medication.
Keywords: Angina; exercise; inorganic nitrate; ischemia; nitrite; randomized trial
Rights: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
RMID: 0030088728
DOI: 10.1161/JAHA.117.006478
Appears in Collections:Medicine publications

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