1. In the normal blood vessel, the vascular endothelium regulates the tone of the underlying smooth muscle and the reactivity of blood elements, such as platelets and neutrophils, by the release of mediators, in particular nitric oxide (NO) and endothelin-1 (ET-1). 2. Nitric oxide is a potent vasodilator that also inhibits platelet and neutrophil aggregation and adhesion; ET-1 is the most potent mammalian vasoconstrictor peptide yet found. Recently, much research effort has focused on examining the interactions between these two important mediators. At a simple level, ET-1 acts on specific receptors on the endothelium to increase the release of NO, while NO depresses the production and/or release of ET-1 from endothelial cells. 3. While ET-1 appears to have a relatively small influence on the basal regulation of blood pressure, NO appears central. For example, inhibition of NO production in normotensive animals produces a marked elevation in blood pressure. 4. Conversely, numerous vascular disease states have been associated with elevations in the production and/or release of ET-1 and it has been implicated in the deleterious changes associated with ischaemia-reperfusion injury, subarachnoid haemorrhage and hypertension. In these conditions, NO production may also be increased by the induction of NO synthetic pathways within the vascular smooth muscle. Endothelin-1 may also be produced by the vascular smooth muscle under similar circumstances. 5. Therefore, in pathological states, a new balance between NO and ET-1 production may be central to changes in blood vessel reactivity, smooth muscle proliferation and blood coagulability.