The presence of ATP-sensitive potassium channel (KA,P) in a variety of tissues makes it an important therapeutic target for drug research. The existence of small molecules that modulate its activity has attracted a great deal of attention over the past several years. Progress achieved at understanding the structure-activity relationships of K, , , openers, and their therapeutic utilities and mechanism of action are summarized in this review. The compounds combining the features of potent K, , , openers cromakalim, pinacidil, and aprikalim retain the biological profiles of their predecessors, indicating the classical K, , , openers may be expressing their biological effects through similar structural requirements. Based o n these studies, a pharmacophore model which incorporates a lipophilic residue, an electron deficient aromatic ring, and a hydrogen bonding site has been proposed. Although the first generation compounds have served as extremely useful tools., their therapeutic utility i s limited due to indiscriminate actions in a variety of tissues. Tissue selective K, , , openers are required to advance these compounds into clinical practice. Progress made at the discovery of selective K , , openers that might be useful for the treatment of ischemic heart disease, urinary incontinence, and asthma is described in this article. The molecular mechanism of action of KATr openers i s far from being understood. A binding site for these agents has been identified in the rat aortic smooth muscle cells and intact rat aortic tissue. However, the relationship of this binding site to KATP i s not understood at the present time. Further work is needed to explore the clinical utility of tissue selective agents and understand their molecular mechanism of action. 8 1994 WiIcy-Lrs5, Inc.