Abstract-An ouabain-like factor has been implicated repeatedly in salt-sensitive hypertension as a natriuretic agent.However, the response of plasma ouabain-like factor to acute and chronic variation of body sodium is unclear. We studied 138 patients with essential hypertension who underwent an acute volume expansion/contraction maneuver (2 days) and 20 patients who entered a blind randomized crossover design involving chronically controlled sodium intake and depletion (170 to 70 mmol/d; 2 weeks each period). In both studies, plasma levels of ouabain-like factor were higher during sodium depletion (acute: 338.8Ϯ17.4 and 402.7Ϯ22.8 pmol/L for baseline and low sodium, respectively, PϽ0.01; chronic: 320.4Ϯ32.0 versus 481.0Ϯ48.1 pmol/L, Pϭ0.01). No significant change in plasma ouabain-like factor was observed after a 2-hour saline infusion (333.4Ϯ23.9 pmol/L) or controlled sodium (402.1Ϯ34.9 pmol/L). When patients were divided into salt-sensitive or salt-resistant groups, no differences in plasma ouabain-like factor were observed in the 2 groups at baseline or in response to the 2 protocols: salt resistant (nϭ69, 340.1Ϯ25.9 pmol/L) versus salt sensitive (nϭ69, 337.4Ϯ23.6 pmol/L) and chronic salt resistant (nϭ11, 336.0Ϯ53.2) versus salt sensitive (nϭ9, 301.1Ϯ331.4 pmol/L). However, circulating ouabain-like factor was increased by sodium depletion in both groups. These results demonstrate that circulating ouabain-like factor is raised specifically by maneuvers that promote the loss of body sodium. Acute expansion of body fluids with isotonic saline is not a stimulus to plasma ouabain-like factor. Moreover, basal levels of plasma ouabain-like factor do not differ among patients with salt-sensitive or salt-resistant hypertension. Taken together, these new results suggest that ouabain-like factor is involved in the adaptation of humans to sodium depletion and argue against the hypothesis that ouabain-like factor is a natriuretic hormone. Key Words: sodium pump inhibitor Ⅲ endogenous Ⅲ salt sensitivity Ⅲ high blood pressure T he involvement of a natriuretic hormone in the control of sodium homeostasis was hypothesized Ϸ40 years ago.