The pathophysiological basis of antianginal therapy with vasodilating agents is critically reviewed. The concept of specific coronary vasodilation should not be pursued in the search for new antianginal agents. Although controlled clinical trials with coronary vasodilators in patients have been successful, no inferences can be drawn as to the concept of coronary vasodilation since most of these compounds vasodilate only the coronaires of experimental animals after i.v. administration but not those of humans after oral ingestion. The stimulating influence of coronary vasodilators on coronary collaterals is an interesting but so far unproven claim. Nitroglycerine dilates the large epicardial coronary vessels. This effect can be of significance in excentric stenoses where the arterial wall is to a small part intact.