To investigate the pathophysiological role of the sympathetic nervous system in essential hypertension, this study recorded the muscle sympathetic nerve activity (MSNA) of the tibial nerve and examined the age-related changes in patients with essential hypertension and in normotensive persons. There were 43 normotensive subjects (16-69 years old) and 63 patients with essential hypertension (18-67 years old) in the study. The MSNA at rest, recorded by microneurography, was evaluated by burst rate (bursts/min), burst incidence (bursts/100 heart beats), and spike frequency (spikes/min). The MSNA recording showed a high reproducibility with a correlation coefficient of 0.86 (p<0.0l) in repeated studies. The MSNA was significantly greater in the hypertensive patients than in the normotensive subjects, irrespective of activity units (p<0.0l), and this finding was consistent in the young (30 years old or less), middle-aged (31-50 years old), and old groups (51 years old or more). Furthermore, MSNA showed a significant positive correlation with age both in the normotensive subjects (r=0.43, p<0.01 for burst rate; r=0.49, /?<0.01 for burst incidence; and r=0.50, p<0.01 for spike frequency) and in the hypertensive patients (r=0.40,/><0.01 for burst rate; r=0.44,p<0.01 for burst incidence; and r=0.40, /><0.01 for spike frequency). Although there was a significant positive correlation between plasma norepinephrine concentration and MSNA in the hypertensive patients and the normotensive subjects, the difference in plasma norepinephrine concentration between the two groups was not significant at any age level. These results indicate that sympathetic nerve activity is increased in patients with essential hypertension at any age level and plays a long-term role in the development and maintenance of blood pressure elevation. (Hypertension 1989; 13:870-877)