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Nitroglycerin—the first one hundred years: new facts about an old drug

one hundred years ago William Murrell published a series of papers in the Lancet in which he described his own experiences (and those of ‘his friends and others’) with ‘nitro-glycerine’ (Murrell 1879). Using sphygmograph he found that six or seven minutes after an oral dose the pulse pressure, heart rate and the rate of rise of systolic pressure increased and the dicrotic notch became more prominent. He wrote that ‘from a consideration of the physiological action of the drug and more especially from the similarity existing between its general action and that of nitrite of amyl, I concluded that it would probably prove of service in the treatment of angina pectoris, and I am happy to say that this anticipation has been realized’. This is a remarkable statement and surely Murrell, had he understood the term, could have claimed to have been one of the first ‘clinical pharmacologists’. It was because of the ‘physiological’ effects of the drug in normal individuals that led him to prescribe it for angina and although it is unlikely that his explanation, and that of Lauder Brunton before him, for the clinical efficacy of amyl nitrite and nitroglycerin is the correct one (reduction in ventricular afterload) it is certainly the reason for the recent proven efficacy of nitroglycerin in the treatment of cardiac failure secondary to acute myocardial infarction. There is no doubt as to the effectiveness of nitroglycerin in angina pectoris (Aronow 1972) and it is not the purpose of this review to provide a comprehensive account of the pharmacology of this remarkable compound. Instead, an attempt will be made to summarize some of the main experimental and clinical findings that have been published over the past five years and especially to discuss the recent evidence for new uses for the drug-namely to reduce myocardial ischaemic damage and to alleviate cardiac failure in acute myocardial infarction. For a discussion of the literature before 1975 the reader is referred to the reviews by Charlier (1971) and by Parratt (1974, 1975).