Abstract-Age-adjusted systolic blood pressure is higher in males than females. Genetic factors may account for this sex-specific variation. To localize sex-specific quantitative trait loci (QTL) influencing blood pressure, we conducted a genome scan of systolic blood pressure, in males and females, separately and combined, and tested for aggregate and QTL-specific genotype-by-sex interaction in American Indian participants of the Strong Heart Family Study. Blood pressure was measured 3 times and the average of the last 2 measures was used for analyses. Systolic blood pressure was adjusted for age and antihypertensive treatment within study center. We performed variance component linkage analysis in the full sample and stratified by sex among 1168 females and 726 males. Marker allele frequencies were derived using maximum likelihood estimates based on all individuals, and multipoint identity-by-descent sharing was estimated using Loki. We detected suggestive evidence of a QTL influencing systolic blood pressure on chromosome 17 at 129 cM between markers D17S784 and D17S928 (logarithm of odds [LOD]ϭ2.4). This signal substantially improved when accounting for QTL-specific genotype-by-sex interaction (Pϭ0.04), because we observed an LOD score of 3.3 for systolic blood pressure in women on chromosome 17 at 136 cM. The magnitude of the linkage signal on chromosome 17q25.3 was slightly attenuated when participants taking antihypertensive medications were excluded, although suggestive evidence for linkage was still identified (LODϭ2.8 in women). Accounting for interaction with sex improved our ability to detect QTLs and demonstrated the importance of considering genotype-by-sex interaction in our search for blood pressure genes. Key Words: epidemiology Ⅲ blood pressure Ⅲ gender S exual dimorphism in the regulation of blood pressure has been demonstrated in several population studies 1-3 and in experimental animal models. 2 Age-adjusted blood pressure is consistently higher in men than women, but these differences are attenuated when women enter menopause. 1 These findings suggest the presence of distinct mechanisms of blood pressure regulation in males and females and stress the importance of the sex hormonal environment in determining blood pressure.Genetic factors account for 30% to 40% of the blood pressure variation in a population, 4 and the effect of some genes may be apparent only in the setting of appropriate sex hormonal milieu. Several genome scans of blood pressure variation have been published, but limited success has been achieved in identifying genes influencing blood pressure in the general population. One reason that few studies have identified significant linkage to blood pressure variation may be genotype-by-sex interaction, which, when present, could reduce the power to localize quantitative trait loci (QTL). Indeed, none of the previous gene mapping studies have accounted for genotype-by-sex interaction on blood pressure variation. In this article, we examine the evidence for genotype-by-sex interact...