SUMMARY Experiments were designed to investigate the importance of vascular endothelium in the vasomotor response to increases in flow as observed in conduit arteries (flow-dependent dilation). The diameter changes of femoral arteries (sonomicrometry) in response to increases in flow before and after endothelial damage procedures were studied in 23 dogs anesthetized with sodium pentobarbital. The functional integrity of the endothelial cells underneath the diameter sensors was tested by intraarterial acetylcholine (local acetylcholine dilation) applied proximally to the sensors while a constant flow was maintained. Unilateral augmentation of femoral arterial flow (4.6 ± 1.9-fold) induced by peripheral vasodilation or by arteriovenous shunt, elicited dilation (increase in diameter, 116 ± 91 fim) in 18 of 23 dogs, whereas the diameter of the contralateral control artery was not affected. Mechanical removal of the endothelial cells by means of a balloon catheter abolished both the flowdependent dilation and the local acetylcholine dilation, whereas the vasomotor responses to norepinephrine and nitroglycerin were not affected. Brief perfusions (1 minute) of the arteries with cell-free hydrogen peroxide solution (90 mM) also abolished the flow-dependent dilation and attenuated the local acetylcholine dilation (by 27 ± 19%; p < 0.02), while the responses to norepinephrine and nitroglycerin were not altered. These results suggest that endothelial cells act as mediators of flowdependent dilation. (Hypertension 8: 37-44, 1986) KEY WORDS • flow-dependent dilation • vascular endothelium • endothelium-mediated dilation • hydrogen peroxide T HE dilator response of conduit arteries to an augmentation of blood flow (flow-dependent dilation) was observed more than 50 years ago, 1 and flow-dependent dilation has been suggested as the principal response in a variety of physiological vascular adaptations, such as collateralization and long-term diameter adaptation to increased flow loads.2 However, the underlying mechanism of this vasodilation is still a matter of debate. Originally the vasodilation was thought to be elicited by a peripheral conducting mechanism, 13 but more recent experiments clearly indicate that a local mechanism is responsible. 4 This explanation implies that vascular wall structures sensitive to flow changes are involved.In view of the accumulating evidence for the modifying role of the vascular endothelium on vascular reactivity, and based on preliminary experiments in isolated arteries, we proposed that the vasodilation in response to flow increases is an endothelium-mediated reaction. 5 The goal of the present study was to demonstrate that the endothelium is functionally important in flow-dependent dilation under in vivo conditions.