What is the mechanism of nitroglycerin in managing angina?

Nitroglycerin primarily manages angina through its action on vascular smooth muscle. It stimulates guanylate cyclase, which leads to an increase in cyclic guanosine monophosphate (cGMP) levels. Elevated cGMP causes relaxation of smooth muscle and subsequent vasodilation, particularly in the veins. This vasodilation reduces venous return (preload), subsequently lowering the workload of the heart and decreasing oxygen demand, which is beneficial in the treatment of angina.

Additionally, nitroglycerin can also dilate coronary arteries, enhancing blood flow to the myocardium, further assisting in alleviating anginal pain. The mechanism of action via cGMP is a fundamental aspect of how nitroglycerin provides its therapeutic effects, making this option the correct choice.