Abstract:

BACKGROUND: Nitroglycerin is widely used as first-line drug to treat unstable angina pectoris, but the development of tolerance is a major problem that may reduce its clinical efficacy. It has been suggested that the addition of other drugs to nitroglycerin can reverse the development of tolerance, potentiate the hemodynamic response to nitroglycerin and may improve therapy prognosis in unstable angina pectoris.
OBJECTIVE: To evaluate whether nitroglycerin combined with drugs show better curative effects than nitroglycerin alone in treatment of unstable angina pectoris.
METHODS: A computer-based online search of Cochrane Library, Medline(ovid), EMbase, Science direct, SIGLE, GreyNet, CBMdisc, VIP, CNKI and Wanfang Data for the clinical randomized controlled trials (RCTs) of nitroglycerin alone and its combination of drugs for treating unstable angina pectoris. Hand searching was also done to obtain any further information about the studies. After the quality of RCTs was evaluated, a meta-analysis was performed by RevMan 5.0.0 for clinical and electrocardiogram (ECG) efficacy.
RESULTS AND CONCLUSION: A total of eight RCTs about 715 patients were included, the quality of RCTs are all B level. Meta-analysis indicates that nitroglycerin combined with other drugs is superior to nitroglycerin alone in terms of clinical and ECG efficacy in treating unstable angina pectoris (RR = 0.79, 95%CI: 1.56-3.08, P < 0.01; RR = 0.72, 95%CI: 0.64-0.81, P < 0.01). However, various biases may exist in the above results, so the combined drugs should be chosen according to clinical symptoms and evidence-based guidelines.