Abstract-The relationship between adrenergic stimuli and NO in modulating tissue-type plasminogen activator (t-PA) release from endothelial cells was investigated in normotensive subjects and essential hypertensive patients. Sympathetic activation, a well-known stimulus for endogenous fibrinolysis, is also involved in the determination of cardiovascular risk in essential hypertension. However, the existence of cross-talk between adrenergic stimuli and NO availability in modulating t-PA release is not well established yet. We assessed the release of t-PA in the forearm microcirculation of 58 normotensive subjects (mean age: 47Ϯ9 years) and 44 essential hypertensive patients (mean age: 48Ϯ11 years) under specific intra-arterial adrenergic stimuli. Intrabrachial infusion of epinephrine (0.1 to 0.3 g/100 mL per minute) induced greater t-PA release in normotensive subjects as compared with essential hypertensive patients (PϽ0.05). However, inhibition of NO synthase with N G -monomethyl-L-arginine (100 g/100 mL per minute) infusion blunted epinephrine-induced t-PA release in normotensive subjects (PϽ0.05) but not in essential hypertensive patients. In normotensive subjects, t-PA release by epinephrine was not affected by phentolamine (8 g/100 mL per minute) coinfusion and was abolished in the presence of propanolol (10 g/100 mL per minute). Intrabrachial isoproterenol (0.03 g/100 mL per minute) induced a significant increase in t-PA release (PϽ0.01), an effect blunted by N G -monomethyl-L-arginine (PϽ0.05). In essential hypertensive patients, the response to isoproterenol was impaired as compared with normotensive subjects and was unaffected by N G -monomethyl-L-arginine coinfusion. In conclusion, the results of the present study demonstrate that adrenergic-induced t-PA release is mediated by -adrenoreceptors via a mechanism involving the NO pathway. Our results show an impaired adrenergic-stimulated t-PA release among essential hypertensive patients, probably mediated via a reduced NO availability. This impaired fibrinolytic activity might contribute to the increased cardiovascular risk associated with hypertension. (Hypertension. 2008;52:314-321.) Key Words: t-PA Ⅲ receptors Ⅲ adrenergic- Ⅲ NO Ⅲ endothelium Ⅲ hypertension Ⅲ essential T he endogenous fibrinolytic system contributes to the maintenance of vessel patency via the cleavage of insoluble fibrin by plasmin. The activation of plasmin by tissue-type plasminogen activator (t-PA) is a physiological process that, clearing inappropriate intravascular fibrin deposition, prevents vascular atherothrombotic events. 1,2 The coagulation factors thrombin and activated factor X, acting as counterregulatory mechanisms during fibrin deposition, are considered the main stimuli for acute t-PA release from endothelial cells. 2 Thus, the vascular endothelium plays a major regulatory role in endogenous fibrinolysis. 3 One of the main mechanisms by which a healthy endothelium regulates acute release of t-PA involves the NO pathway. 4 In certain pathological conditions charact...