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There was a marked increase in exercise time 1 hour after active nitroglycerin patch application from 271 ±16 s to 480 ±47 s (p<0.001). This increase diminished somewhat by 3 hours after patch application, but thereafter there was a continuous and relatively constant superiority of performance compared with the placebo day, through the 7 pm test. Mean exercise performance at 24 hours was better than control and placebo values; however, there was a dichotomy in patient performance. Four patients showed no improvement over placebo ( + 6, —20, + 29, and —35 s), whereas the other four patients showed significant improvement (+ 130, +92, +157, and + 64 s). Blood Pressure There was a marked fall in mean sitting systolic blood pressure 1 hour after active patch application from 122 ±4 mm Hg to 100 ±5 mm Hg (p<0.001) (Fig 2 and Table 2). This decrease was maintained in a somewhat diminished degree throughout the day. One of the eight patients showed no fall in systolic blood pressure despite an increase in exercise time. Heart Rate Heart rate changes were insignificant 1 hour after placebo patches (from 57 to 56 bpm) as well as after nitroglycerin patches (from 58 to 60 bpm), since patients were receiving (3-blockers. Figure 2. Mean resting systolic blood pressure just before exercise at different hours during the placebo and nitroglycerin patch days. Patches were applied after the 8 am bout. See Table 2 for p values. Table 2—Mean Values for Resting Systolic Blood Pressure on Placebo and Nitroglycerin Patch Days (mm Hg)

Time	Placebo	Nitroglycerin  Patch	P
8 am (baseline)	121 ±5	122 ±4	0.6
9 AM	119±6	100 ±6	0.0000*
11 AM	118 ±5	97 ±3	0.0009*
1 PM	118 ±5	97 ±4	0.0002*
2 pm	121 ±6	98±4	0.0001*
4 PM	118 ±5	101 ±3	0.0024*
6 PM	120 ±4	106 ±5	0.0007
7 PM	128 ±5	109 ±5	0.0002*
8 am (+ 1 day)	122 ±4	107 ±4	0.0033*