1 Tolerance to the hypotensive e ect of nitroglycerin (NG) blocks preconditioning induced by rapid ventricular pacing (RVP) in rabbits. In the present work the e ect of continuous versus intermittent treatment with transdermal nitroglycerin on the pacing-induced preconditioning phenomenon was studied in conscious rabbits. 2 RVP (500 beats min 71 over 5 min) increased left ventricular end-diastolic pressure (LVEDP) from baseline 4.1+0.9 to postpacing 13.8+2.9 mmHg (P50.001) with a right intraventricular ST-segment elevation of 1.25+0.13 mV, two indicators of myocardial ischaemia. These changes were signi®cantly attenuated when the RVP period was preceded by a preconditioning pacing of the same rate and duration with an interpacing interval of 5 min. 3 Protection by preconditioning was abolished when the animals had been made tolerant to the vasodilator e ect of 30 mg kg 71 NG by the application of transdermal NG (approx. 0.07 mg kg 71 h 71 ) over 7 days. Furthermore, transdermal NG per se attenuated both RVP-induced ST-segment elevation and LVEDP-increase over the 7 day period. 4 With intermittent transdermal NG treatment (12 h`patch on' vs`patch o '), neither development of vascular tolerance nor attenuation of the NG-or preconditioning-induced anti-ischaemic e ects were observed. However, the severity of pacing-induced myocardial ischaemia was signi®cantly increased during the`patch o ' periods. 5 In a second set of experiments, postpacing changes in cardiac cyclic GMP and cyclic AMP levels were determined by means of radioimmunoassay in chronically instrumented anaesthetized open-chest rabbits with the same NG-treatment protocols. Preconditioning reduced postpacing increase in cyclic AMP with an increase in cyclic GMP concentrations in hearts of the untreated animals and in those given patches intermittently during both`patch on' and`patch o ' periods. However, the preconditioning e ect on either cyclic nucleotide was blocked in the tolerant animals. 6 Transdermal NG increased resting levels of both cardiac cyclic nucleotides in the non-tolerant but not in the tolerant state. The postpacing increase in cyclic AMP content was inhibited by transdermal NG, independent of vascular tolerance development, whereas, an increase in cyclic GMP content was exclusively seen in the non-tolerant animals. 7 We conclude that the anti-ischaemic e ect of NG is independent of the cyclic GMP mechanism in the tolerant state. While intermittent NG therapy prevents development of vascular tolerance and preserves preconditioning, the nitrate-free periods yield an increased susceptibility of the heart to ischaemic challenges.