EC Pharmacology and Toxicology

Mini Review Volume 11 Issue 3 - 2023

Therapeutic Role of Nitroglycerin: Treatment and Preservation Endothelial Dysfunction in the Perioperative and ICU Settings in High Risk Patients

Duraiyah Thangathurai1* and Elizabeth Hong2

1Professor of Clinical Anesthesiology, Surgery and Urology, Director of Department Development, Department of Anesthesiology, University of Southern California, LA, CA, USA
2Assistant Professor Clinical Anesthesiology, LAC/USC Medical Center, LA, CA, USA

*Corresponding Author: Duraiyah Thangathurai, Professor of Clinical Anesthesiology, Surgery and Urology, Director of Department Development, Department of Anesthesiology, University of Southern California, LA, CA, USA.
Received: February 13, 2023; Published: February 27, 2023



Nitroglycerine (NTG) and other nitric oxide donors (NO) play a key role in maintaining endothelial function thereby improving microcirculation of the tissues, including vital organs. There are several mechanisms of actions including improvement of the integrity the of endothelial system, and expansion of intravascular volume, resulting increased perfusion, and minimizing the release and the effect of inflammatory mediators including cytokines. Historically nitroglycerine, has been used to improve coronary circulation in patients with angina. Recent studies show it is useful in protecting all the vital organs. In addition to the benefit in angina, it is also useful in heart failure. It improves diastolic dysfunction, lowers pulmonary artery pressures, and improves right heart failure. It is helpful to maintain integrity of the pulmonary endothelium and prevent ARDS related complications. Additionally, nitroglycerin also improves rheology of red cells and decrease viscosity (improving deformability) and improve the microcirculatory flow. This is beneficial in hyper viscosity conditions, hemoglobinopathies such as sickle cell anemia, and similar disorders. Storage of blood is associated with increased deformity of red cells, decreased flexibility increased viscosity, changes in rheology, causing resistance to capillary blood flow. Deformed red cells are more susceptible to hemolysis. Nitroglycerine improves cerebral oxygenation, and increase mixed venous oxygen values, probably from increasing the capacity of whole microcirculatory system.

Keywords: Nitroglycerin; Endothelium; eNOS; Mitochondria; Nitric Oxide (NO)

  1. Klinger JR., et al. “Nitric oxide deficiency and endothelial dysfunction in pulmonary arterial hypertension”. American Journal of Respiratory and Critical Care Medicine6 (2013): 639-646.
  2. Divakaran S and Loscalzo J. “The Role of Nitroglycerin and Other Nitrogen Oxides in Cardiovascular Therapeutics”. Journal of the American College Cardiology19 (2017): 2393-2410.
  3. Chia PY., et al. “Overview of the assessment of endothelial function in humans”. Frontiers in Medicine 7 (2020): 542567.
  4. Vallance P., et al. “Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure”. Lancet 8793 (1992): 572-575.
  5. Su JB. “Vascular endothelial dysfunction and pharmacological treatment”. World Journal of Cardiology11 (2015): 719-741.
  6. Boger RH., et al. “Asymmetric dimethylarginine (ADMA): a novel risk factor for endothelial dysfunction: its role in hypercholesterolemia”. Circulation18 (1998): 1842-1847.
  7. Moncada S and Higgs EA. “The discovery of nitric oxide and its role in vascular biology”. British Journal of Pharmacology1 (2006): S193-S201.
  8. Ince C., et al. “The endothelium in sepsis”. Shock3 (2016): 259-270.
  9. Duplain H., et al. “Insulin resistance, hyperlipidemia, and hypertension in mice lacking endothelial nitric oxide synthase”. Circulation3 (2001): 342-345.
  10. Inoguchi T., et al. “High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C--dependent activation of NAD(P)H oxidase in cultured vascular cells”. Diabetes 11 (2000): 1939-1945.
  11. Panza JA., et al. “Impaired endothelium-dependent vasodilation in patients with essential hypertension. Evidence that nitric oxide abnormality is not localized to a single signal transduction pathway”. Circulation 6 (1995): 1732-1738.
  12. Schlaich MP., et al. “Impaired L-arginine transport and endothelial function in hypertensive and genetically predisposed normotensive subjects”. Circulation24 (2004): 3680-3686.
  13. Martens CR and Edwards DG. “Peripheral vascular dysfunction in chronic kidney disease”. Cardiology Research and Practice 2011 (2011): 267257.
  14. Martens CR., et al. “Impaired L-arginine uptake but not arginase contributes to endothelial dysfunction in rats with chronic kidney disease”. Journal of Cardiovascular Pharmacology1 (2014): 40-48.
  15. Liu LP., et al. “Clinical efficacy of nitroglycerin in patients with septic shock with ARDS”. Medical Journal of Chinese People’s Liberation Army8 (2015).
  16. Yamakado T., et al. “Effects of nitroglycerin on left ventricular systolic, diastolic and regional myocardial function in patients with coronary artery disease”. Journal of Cardiography2 (1985): 273-284.
  17. van Manen L., et al. “Effect of red blood cell transfusion on inflammation, endothelial cell activation and coagulation in the critically ill”. Vox Sanguinis1 (2021): 64-70.
  18. Bor-Kucukatay M., et al. “The effects of nitric oxide on red blood cell deformability”. American Journal of Physiology5 (2003): H1577-H1584.
  19. Bor-Kucukatay M., et al. “Red blood cell rheological alterations in hypertension induced by chronic inhibition of nitric oxide synthesis in rats”. Clinical of Hemorheology and Microcirculation4 (2000): 267-275.
  20. Bin JP., et al. “Effects of nitroglycerin on erythrocyte rheology and oxygen unloading, novel role of S-nitrosohemoglobin in relieving myocardial ischemia”. Circulation21 (2006): 2502-2508.
  21. Ando J and Kamiya A. “Blood flow and vascular endothelial cell function”. Frontiers of Medical and Biological Engineering4 (1993): 245-264.
  22. Marsh N and Marsh A. “A short history of nitroglycerine and Nitric oxide in pharmacology and physiology”. Clinical Experimental Pharmacology and Physiology 4 (2000): 313-319.
  23. Thangathurai D., et al. “Complications during cardiac anesthesia”. Seminars in Anesthesia3 (1996).
  24. Thangathurai D., et al. “Intraoperative maintenance of tissue perfusion prevents ARDS. Adult respiratory distress syndrome”. New Horizon4 (1996): 466-474.
  25. Baylis C. “Nitric oxide deficiency in chronic kidney disease”. American Journal of Physiology - Renal Physiology1 (2008): F1-F9.
  26. Davison SM and Duchen MR. “Endothelial mitochondria: Contributing to vascular function and disease”. Circulation Research8 (2007): 1128-1141.
  27. Gao S., et al. “Docking of endothelial nitric oxide synthase (eNOS) to the mitochondrial outer membrane”. Journal of Biological Chemistry16 (2004): 15968-15974.
  28. Litvinova L., et al. “Nitric oxide and mitochondria in metabolic syndrome”. Frontiers in Physiology 6 (2015): 20.
  29. Mikhail M., et al. “Echocardiograpic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin”. Journal of Cardiothoracic and Vascular Anesthesia5 (2000): 565-570.
  30. Van Noord BA., et al. “The use of regional cerebral oximetry monitoring during controlled hypotension: A case series”. Journal of Clinical Monitoring and Computing3 (2014): 319-323.
  31. den Uil CA., et al. “Low dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure”. European Journal of Heart Failure4 (2009): 386-390.
  32. Lima A., et al. “Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock”. Critical Care3 (2014): R126.
  33. Kawashima M., et al. “Cytoprotective effects of nitroglycerin in ischemia-reperfusion-induced lung injury”. American Journal of Respiratory and Critical Care Medicine3 Pt 1 (2000): 935-943.
  34. McMahon TJ. “Red blood cell deformability, vasoactive mediators, and adhesion”. Frontiers in Physiology 10 (2019): 1417.

Duraiyah Thangathurai and Elizabeth Hong. Therapeutic Role of Nitroglycerin: Treatment and Preservation Endothelial Dysfunction in the Perioperative and ICU Settings in High Risk Patients. EC Pharmacology and Toxicology 11.3 (2023): 80-85.

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