T he work by Karamat et al 1 contains evidence that creatine kinase (CK) mRNA in vascular smooth muscle has a direct correlation with blood pressure. This result is both interesting and problematic: there is no previous evidence from in vitro experiments that smooth muscle CK is a regulatory enzyme, and there is considerable evidence that the enzyme is at equilibrium inside cells. As the data indicate a regulatory role for the equilibrium enzyme CK in control of blood pressure, the general problem of investigating the role of an equilibrium enzyme in a regulatory system is inherently intriguing.Cytosolic CK has been always considered an equilibrium enzyme, whether in striated or smooth muscle. This assumption was used to calculate the free concentration of ADP in cells, in which the concentrations of ATP, PCr, and creatine could be determined. Phosphate NMR was used to measure the relative free concentrations of ATP, PCr, and Pi, and from the chemical shifts of Pi and β-ATP, the pH and free Mg ++ of the cell could also be determined. Coupled with chemical measurements of creatine, and using in vitro measurements of the CK equilibrium constant, the free concentration of ADP (and thus the free energy of the cell) could be calculated. Measurements of free ADP cannot be made from chemical analyses because ADP liberated from f-actin compromises these measurements.2 ADP could not be seen as a peak in striated muscle phosphate NMR because of both its low concentration and chemical shift similarity to the ATP resonances. The lower concentration of Mg ++ in smooth muscle meant that β-ADP had a different chemical shift from γ-ATP, and ADP peaks could be seen under anoxic conditions in vascular smooth muscle.3 Using the relative concentrations of ADP from these experiments, it was shown that smooth muscle CK is both at equilibrium, and has an equilibrium constant inside cells consistent with its in vitro determination. Given this, the results presented herein are unexpected.All living biological systems have to exist at free energy levels greater than that of the local ambient energy. Systems can only exist at a steady state in this elevated energy state with the constant input of energy exactly balancing the increase in entropy of the system over time. Maintenance of a living system requires that the system be in a nonequilibrium state. However, this requirement does not mean that every part of the system must always be in a nonequilibrium state. In the glycolytic pathway for instance, hexokinase, phosphofructokinase, and pyruvate kinase all have free energies that indicate nonequilibrium states, while all of the other enzymes are at equilibrium. 4 Furthermore, PFK is a regulatory enzyme, exhibiting rate changes produced by nonsubstrate molecules as well as crossover conditions in which the rate can be shown to increase even when the substrate concentration decreases. 5 CK has never been shown to have these properties. Thus, an increase in energy flux tied to CK concentrations can only occur if the flux is rate limited by...