Endothelium-dependent vasodilation is impaired in clinical states of insulin resistance such as obesity and type 2 diabetes. Individuals who have hyperinsulinemic insulin resistance have relatively elevated circulating levels of endothelin (ET)-1, suggesting that ET-1 may be important in the endothelial dysfunction and alterations of vascular tone in these conditions. In 8 lean subjects, 12 nondiabetic obese subjects, and 8 subjects with type 2 diabetes, we measured basal and methacholine-stimulated rates of leg blood flow (LBF) and total serum nitrates (NOx) before and after the intrafemoral arterial administration of BQ123, a specific blocker of ET A receptors. BQ123 produced significant vasodilation in the obese and type 2 diabetic subjects (leg vascular resistance ؍ mean arterial pressure/LBF fell by 34 and 36%; P < 0.005) but not in the lean subjects (13%; P ؍ NS, P ؍ 0.018 comparing all groups). ET A blockade did not change basal NOx flux (NOx*LBF). This suggests increased basal ET-1 constrictor tone among obese and type 2 diabetic subjects. BQ123 corrected the baseline defect in endothelium-dependent vasodilation seen in obese and type 2 diabetic subjects, suggesting an important contribution of ET-1 to endothelial dysfunction in these subjects. In contrast to basal conditions, stimulated NOx flux was augmented by BQ123 in obese and type 2 diabetic subjects but not in L subjects (P ؍ 0.04), suggesting a combined effect of ET A blockade to reduce constrictor tone and augment dilator tone. Endothelin seems to contribute to endothelial dysfunction and the regulation of vascular tone in human obesity and type 2 diabetes. Diabetes 51: [3517][3518][3519][3520][3521][3522][3523] 2002 T he endothelial dysfunction observed in the insulin-resistant states of obesity and type 2 diabetes has been attributed to decreased nitric oxide (NO) availability (1,2), likely related to both impaired production and increased consumption (3,4). However, paracrine control of vascular tone depends on the balance of both vasodilating and vasoconstricting factors (5). Endothelin (ET)-1, produced directly by vascular endothelial cells, is the most important locally produced vasoconstrictor, acting principally through type A (ET A ) receptors on vascular smooth muscle cells (6). ET-1 and NO function as mutual antagonists in the determination of vascular tone but also have important direct interactions at the level of transcription and expression (7) and signal transduction (8), with each acting to limit the net production of the other. This mutual antagonism can serve to amplify any imbalances resulting from other factors, for example insulin resistance/hyperinsulinemia. Furthermore, both ET-1 and NO have effects beyond their contributions to the regulation of vascular tone, which act in net as antiatherosclerotic (NO) or proatherosclerotic (ET-1) factors through modulation of platelet activity, lipid oxidation, leukocyte chemotaxis, and local production of thrombotic factors as well as the growth and proliferation of vascul...