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Discussion Batch Dose The doses that we found necessary (mean, 125 sq cm) to produce a day-long antianginal effect are far greater than those generally used in clinical practice, and much greater than those used in most studies. We believe strongly, however, that the rigorous, exercise test-based method of dose titration in patients already taking ISDN on a long-term basis indicates that such “high” doses are, in fact, the doses necessary to obtain the desired long-term effect from nitroglycerin patches. Studies that have found antianginal effectiveness from doses in the range of 10 to 40 sq cm were generally short-term studies and used patients not receiving long-term nitrate therapy. Other studies using these doses have found no antianginal effect at all i4,15 Moreover, the studies that found an antianginal effect at these low doses almost universally found no effect at 24 hours or loss of effect after 1 week of continuous use. None of these studies found mean peak increases in exercise time even approaching the 209 s we found. revious studies that have purported to dose-titrate patients to an effective individual patch dose have done so by the induction of a 10 mm Hg fall in systolic blood pressure or a 10 bpm rise in heart rate, or by the use of maximally tolerated doses, which has generally meant the appearance of headache.