What are the effects of nitrates on the cardiovascular system?
Nitrates are endothelium-independent vasodilators with peripheral and coronary vascular effects. By dilating the capacitance vessels, nitrates decrease cardiac preload and reduce ventricular wall tension. More modest effects on the arterial circulation result in afterload reduction and further decrease in left ventricular (LV) end-diastolic pressure. This may be partially offset by reflex increases in heart rate and contractility, which counteract the reduction in myocardial oxygen demand (MVO2) unless a beta blocker is concurrently administered. Nitrates also dilate normal and atherosclerotic coronary arteries and increase coronary collateral flow.