Abstract-Experimental evidence indicates that endothelin 1 stimulates the sympathetic nervous system by activation of the subtype A receptor. The aim of the present study was to assess whether this mechanism is active in humans and to investigate its potential role in the pathogenesis of essential hypertension. In 15 hypertensive patients and 12 normotensive subjects, blood pressure, heart rate, and muscle sympathetic nerve activity were evaluated during intravenous 20-minute infusion of BQ123 (0.1 mg/kg per hour), an endothelin A receptor antagonist, and sodium nitroprusside (SNP; 0.4 g/kg per minute). In hypertensive patients, blood pressure was reduced similarly by BQ123 and SNP. In contrast, the increase in muscle sympathetic nerve activity induced by BQ123 (from 52.0Ϯ4.9 to 56.8Ϯ5.5 bursts per 100 heartbeats; PϽ0.05 versus baseline) was significantly lower (PϽ0.05) than that induced by SNP (from 50.6Ϯ4.9 to 61.1Ϯ5.1 bursts per 100 heartbeats; PϽ0.05 versus baseline). In normotensive subjects, SNP reduced blood pressure and increased muscle sympathetic activity, whereas BQ123 was ineffective. Thus, in a subgroup (nϭ9) of normotensive subjects, we administered BQ123 at a higher dose ( Key Words: hypertension Ⅲ sympathetic nervous system Ⅲ endothelin Ⅲ microneurography Ⅲ BQ123 E ssential hypertension is characterized by increased sympathetic nervous system (SNS) activity, as clearly demonstrated by sensitive techniques, such as the norepinephrine (NE) spillover method 1 and microneurographic quantification of nerve traffic. 2 SNS activation, which is already present in normotensive offspring of hypertensive patients, 3 is peculiar to the essential hypertensive state 2 and parallels the degree of blood pressure (BP) increase. 2 In addition, it may exert deleterious metabolic and cardiovascular effects, accelerating progression of the target organ damage associated with hypertension. 4 Endothelin 1 (ET-1) is a vasoconstrictor and mitogenic peptide produced by endothelial cells. Its important role in regulation of vascular tone and structure is well established. 5 Essential hypertension is characterized by increased ET-1 vasoconstrictor tone, 6,7 which seems to be a consequence of reduced NO availability. 7 Endothelin receptor antagonists, particularly those acting on endothelin A (ET A ) receptors, are a promising therapeutic option in patients with resistant 8 and renoparechimal 9 hypertension. The role of the endothelin system in cardiovascular homeostasis is not limited to its direct vascular effects but also involves neural regulation of vasomotor tone. 10 Experimental evidence suggests that ET-1 can stimulate central and peripheral SNS activity through ET A receptors. 11,12 Although intracerebral administration of ET-1 can increase BP and SNS activity mainly through ET A receptors in hypertensive as well normotensive animals, 11,12 administration of an ET A receptor antagonist induces the opposite effect in hypertensive animals only, suggesting a specific sympathoexcitatory role for the endothelin system in...