Glyceryl trlnitrate, isosorbide dinitrate, and isosorbide-o-mononitrate are organic nitrate esters commonly used in the treatment of angina pectoris, myocardial infaretion, and congestive heart failure. Organic nitrate esters have a direct relaxant effect on vascnlar smooth mnscles, and the dilation of coronary vessels improves oxygen snpply to the myocardium. The dilation of peripheral veins, and in higher doses peripheral arteries, rednces preload and afterload, and thereby lowers myocardial oxygen consumption. Inhibition of platelet aggregation is another effect that is probably of therapeutic value. Effects on the central ne"ous system and the myoeardium have been shown but not scrutinized for therapeutic importance. Both the relaxing effect on vascular smooth musele and the effect on platelets are considered to be due to a stimulation of soluble guanylate cyclase by nitric oxide derived from the organic nitrate ester molecule through metabolization catalyzed by enzymes such as glutathione 8-transferase, cytochrome P-450, and possibly esterases. The cyclic GMP produced by the guanylate cye ....... acts via cGMPdependent protein kinase. Ultimately, through various processes, the protein kinase lowers intracellular calcium; an increased uptake to and a decreased release from intracellular stores seem to be particularly important.Keg Words. organic nitrate esters, glyceryl trlnitrate, nitroglycerin, isosorbide dinitrate, isosorbide-o-mononitrate, cyclic GMP Nitroglycerin was introduced as a therapeutic agent for the treatment of angina pectoris more than a century ago [1], and since then several other nitro compounds with similar chemical properties have been introduced, for example, isosorbide dinitrate (ISDN), isosorbide-5-mononitrate (IS-5-MN), and pentaerythritol tetranitrate. An essential feature of all these compounds is a nitrate ester bond (R-O-N02). The nitrate ester group distinguishes the or-21 U. Thadani et al. (eds.), Nitrates Updated