NO-donors in cardiology

Nitrates have been used in the pharmacological treatment of cardiac diseases for over hundred years, at the beginning in the treatment of angina pectoris. Later on the scale of clinical indications has widened towards other diseases where the vasodilating effect of these drugs could be of benefit. The increased interest in nitrates is based on new knowledge about their pharmacokinetics, pharmacodynamics and development of tolerance as well as the new idea of their cellular mode of action. They release nitric oxide, vasodilator and vasorelaxant physiologically originating from the vascular endothelium (EDRF). Nitrates and other NO-donors can substitute for this endogenous factor in the case of diseases endothelium or on other occasions where the production of NO is reduced or abnormally changed to toxic products. It is evident that totally new type of NO-donors like molsidomine and others will appear on the market for the treatment not only of cardiovascular diseases but also other disorders where smooth muscle relaxation is necessary. This review deals with the present status of nitrates in the cardiology and predicts some future aspects in this field.