SUMMARY To determine the role of the peripheral sympathetic nervous system in the persistent tachycardia caused by the antihypertensive drug hydralazine, we examined the temporal relationships between the changes in heart rate and plasma norepinephrine concentration and the reduction in blood pressure produced by a range of doses of hydralazine administered intravenously to five hypertensive patients. Significant linear correlations were found between the increases in heart rate and plasma norepinephrine concentration and the reduction in blood pressure at IS and 30 minutes after injection. However, at 240 minutes after Injection, changes in heart rate and plasma norepinephrine were not correlated with changes in blood pressure and were disproportionately elevated relative to the reduction in blood pressure. A significant linear correlation between changes in heart rate and plasma norepinephrine concentration was noted at 15, 30, and 240 minutes after injection. The temporal discordance of the changes of both heart rate and plasma norepinephrine relative to the reduction in blood pressure and the significant linear correlation between the increases in heart rate and plasma norepinephrine concentration suggest that continued activation of the peripheral sympathetic nervous system contributes to the persistent tachycardia seen after the administration of hydralazine. (Hypertension 5: 257-263, 1983) KEY WORDS • sympathetic nervous system • heart rate • vasodilation T HE decrease in blood pressure (BP) caused by the peripheral vasodilator hydralazine is associated with an increase in heart rate (HR).' 2 The tachycardia is of clinical importance since it favors an increase in cardiac output, which would tend to offset the antihypertensive effect of hyralazine. Accordingly, suppression of hydralazine-induced tachycardia by the coadministration of beta-adrenoceptor antagonists is believed to contribute to the increased efficacy of this combined drug therapy in the treatment of hypertension. 3 ' 4 In addition, the increase in myocardial oxygen consumption associated with the tachycardia may precipitate myocardial ischemia in the presence of atherosclerotic heart disease. Received for publication April 20, 1982; revision accepted September 10, 1982. baroreflexes in response to a reduction in BP, researchers have recognized that the increase in HR persists disproportionately longer than the vasodepressor effect. 6 In addition, several investigators 7 8 have demonstrated that restoration of the systemic BP to normal by the infusion of vasodepressor agents does not completely reverse the tachycardia seen after administration of hydralazine to animals. Thus, arterial baroreflex activation of the peripheral sympathetic nervous system cannot completely account for the persistent tachycardia caused by hydralazine.Although plasma norepinephrine (NE) concentration is known to be increased following administration of hydralazine to animals, 9 the quantitative relationship between the increase in plasma catecholamine levels a...