Do we still need organic nitrates?

rganic nitrates are still quite frequently used for the reatment of acute and chronic angina, and acute and hronic congestive heart failure. When given acutely, their ffectiveness is undisputable; however, their long-term effiacy is substantially limited due to the development of olerance (1) and the induction of endothelial dysfunction (2), parameter that has prognostic significance in patients with oronary artery disease, hypertension, and heart failure (3). In this issue of the Journal, Thomas et al. (4) showed that herapy with isosorbide mononitrate (ISMN) leads to enothelial dysfunction, increases oxidative stress, and that his condition is improved by acute administration of itamin C. One might conclude that this was predictable ince this has been shown for nitroglycerin (GTN) and all itrates are the same. In fact, all nitrates are not all the same nd, therefore, the paper by Thomas et al. (4) has substanial importance.