Oxygen (O 2 ) sensing by the carotid body and its chemosensory reflex is critical for homeostatic regulation of breathing and blood pressure. Humans and animals exhibit substantial interindividual variation in this chemosensory reflex response, with profound effects on cardiorespiratory functions. However, the underlying mechanisms are not known. Here, we report that inherent variations in carotid body O 2 sensing by carbon monoxide (CO)-sensitive hydrogen sulfide (H 2 S) signaling contribute to reflex variation in three genetically distinct rat strains. Compared with SpragueDawley (SD) rats, Brown-Norway (BN) rats exhibit impaired carotid body O 2 sensing and develop pulmonary edema as a consequence of poor ventilatory adaptation to hypobaric hypoxia. Spontaneous Hypertensive (SH) rat carotid bodies display inherent hypersensitivity to hypoxia and develop hypertension. BN rat carotid bodies have naturally higher CO and lower H 2 S levels than SD rat, whereas SH carotid bodies have reduced CO and greater H 2 S generation. Higher CO levels in BN rats were associated with higher substrate affinity of the enzyme heme oxygenase 2, whereas SH rats present lower substrate affinity and, thus, reduced CO generation. Reducing CO levels in BN rat carotid bodies increased H 2 S generation, restoring O 2 sensing and preventing hypoxia-induced pulmonary edema. Increasing CO levels in SH carotid bodies reduced H 2 S generation, preventing hypersensitivity to hypoxia and controlling hypertension in SH rats.high-altitude hypoxia | gasotransmitters | sympathetic tone | cystathionine-γ-lyase O xygen, an essential substrate for generating ATP, is vital for sustaining much of life on earth. A low availability of oxygen directs vertebrates' complex respiratory and cardiovascular systems to maintain optimal oxygenation of tissues by increasing ventilation and blood pressure. Interestingly, ventilatory responses to hypoxia are not uniform but, instead, exhibit substantial variation among humans (1). These varied ventilatory responses to hypoxia result in dire physiological consequences: a diminished hypoxic ventilatory response can result in poor adaptation to low O 2 environments (2) and high-altitude pulmonary edema (3-5), whereas a heightened response is associated with essential hypertension (6). Similar variations in hypoxic response have also been documented in different strains of rodents (7-10). In comparison with Sprague-Dawley (SD) rats, Brown-Norway (BN) rats display a markedly reduced ventilatory response to hypoxia (8, 9), whereas Spontaneous Hypertensive (SH) rats exhibit an augmented response (11). SH rats also present enhanced sympathetic nerve activity and hypertension (7). Despite the physiological significance, the mechanisms underlying interindividual variation in systemic responses to hypoxia are not known.The carotid body is the key sensor of arterial blood oxygen, and its chemosensory reflex is a critical regulator of breathing, sympathetic tone, and blood pressure (12, 13). Differing responses in ventilation an...