Nitroglycerin and other organic nitrates have been used for over a century in the treatment of angina pectoris. Millions of patients, throughout the world, have placed nitroglycerin tablets under the tongue and have experienced rapid and dramatic relief from the chest pain that frequently occurs as a manifestation of disease of the coronary arteries. The empirical observation of the safe use of nitrates for tile alleviation of the symptoms of angina have led to their widespread medical acceptance. The use of organic nitrates preceded any knowledge of their mechanism of action or their ultimate metabolic fate. Thus, more simply stated, although sub lingual nitrates helped the patients, little was known concerning what these drugs do to the body or what the body does to the drugs. A substantial number of investigators have focused on these questions especially during the last two decades. We now have considerably more insight into the pathways of degradation of organic nitrates and the relationship of the metabolic processes to the biological action of these agents. Similarly, considerable effort has been expended in understanding the mechanism of action of these agents directly on vascular smooth muscle and on cardiac work and performance. Finally, there is a more substantive understanding of the physiology of the coronary circulation as well as the" pathophysiologic manifestations of myocardial disease.

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1 Historical Background.- I. Nitrogen and Its Compounds.- II. Biological Occurrence of Nitrites and Nitrates.- III. The Synthesis of Nitrite and Nitrate Esters.- IV. Discovery of Amyl Nitrite.- V. T. Lauder Brunton, England's Leading Therapist.- VI. SirLauder Brunton and Amyl Nitrite.- VII. The Discovery of Nitroglycerin.- VIII. Early Studies on Nitroglycerin in America.- IX. Nitroglycerin or Glonoin.- X. Nitroglycerin in England.- XI. William Murrell.- XII. Amyl Nitrite and Nitroglycerin in Angina Pectoris.- XIII. Organic and Inorganic Nitrites and Nitrates.- XIV. The Influence of Oil Solubility on Nitrate Ester Response.- XV. Nitrites and Nitrates in Hypertension.- XVI. Extending the Duration of Action of Nitroglycerin.- XVII. Summary.- References.- 2 Chemistry of Organic Nitrates.- I. General Properties.- II. Methods of Laboratory Synthesis.- III. Chemical Properties.- IV. Cautions in Handling.- References.- 3 Organic Nitrates: Analytical Techniques.- I. Extraction Procedures.- II. Spectrometric Methods.- III. Chromatographic Procedures.- IV. Use of Labeled Products.- References.- 4 Pharmacological Properties.- I. Action on Vasculature.- II. Cardiovascular Systems.- III. Pulmonary Circulation.- IV. Metabolism of Cardiac Muscle.- V. Actions of Other Smooth Muscles.- VI. Significance of Normal Blood Levels of the Nitrate and Nitrite Ions.- VII. Plasma Levels of Nitrates.- References.- 5 Biotransformation of Organic Nitrates.- I. Isolation and Characterization of Organic Nitrate Reductase.- II. Isolation and Characterization of Organic Nitrate Metabolites.- III. Relationship between Organic Nitrate Metabolism and Biological Activity.- IV. Summary and Conclusions.- References.- 6 The Pharmacological and Biochemical Interaction of Organic Nitrates with Sulfhydryls:Possible Correlations with the Mechanism for Tolerance Development, Vasodilation, and Mitochondrial and Enzyme Reactions.- I. Sulfhydryl Reactivity of Organic Nitrates Introduction.- II. Organic Nitrate-Tolerance.- III. Sulfhydryl Requirement for Relaxation of Vascular Smooth Muscle.- IV. Biochemical Actions of Organic Nitrates.- References.- 7 Physiology and Pathophysiology of the Coronary Circulation and the Role of Nitroglycerin.- I. Normal Physiology.- II. Pathophysiology of Ischemic Heart Disease.- Coronary Occlusion.- III. Action of Nitroglycerin in Relieving Myocardial Ischemia.- IV. Use of Nitroglycerin in Myocardial Infarction.- References.- 8 Mechanism of Action of Nitroglycerin: Coronary, Cardiac, and Systemic Effects.- I. Introduction.- II. Action on the Coronary Circulation.- III. Systemic and Cardiac Effects.- IV. Effects of Nitroglycerin on the Ischemic Myocardium.- V. Summary.- References.- 9 Use of Nitrates as Antianginal Agents.- I. Mechanism of Action of Sublingual Nitrates.- II. Sublingual Nitroglycerin as an Antianginal Drug.- III. Long-Acting Nitrates.- References.- Author Index.