Abstract-To test the hypothesis that NO influences aldosterone production in humans, we examined the effect of N G -nitro-L-arginine methyl ester (L-NAME) on aldosterone concentrations in the presence and absence of the NO precursor L-arginine (3 g TID) and the angiotensin-converting enzyme inhibitor ramipril (10 mg QD). Ten normal subjects were given L-NAME (66 g/kg per min for 30 minutes) or vehicle in random order on separate days during placebo and after randomized, double-blind treatment with L-arginine, ramipril, or L-arginine plus ramipril. Infusion of L-NAME significantly increased systolic blood pressure (all PϽ0.05) and decreased heart rate (all PՅ0.02) during all 4 treatment arms. After placebo pretreatment, serum aldosterone was significantly higher during L-NAME infusion than during vehicle (6.6Ϯ1.7 versus 3.3Ϯ0.5 ng/dL; Pϭ0.045). Combined treatment with L-arginine plus ramipril abolished this effect. There was no effect of L-NAME on plasma renin activity (PRA; Pϭ0.297) or angiotensin II concentrations (Pϭ0.537). However, there was a significant interactive effect of L-NAME and time on serum potassium (Pϭ0.039). There was a significant linear relationship between PRA and aldosterone concentration after vehicle infusion ([aldosterone] Key Words: aldosterone Ⅲ nitric oxide Ⅲ angiotensin-converting enzyme Ⅲ arginine E ndothelial dysfunction, characterized by decreased endothelial NO synthase (NOS) activity, predicts cardiovascular events in patients at risk for coronary artery disease. 1 Studies in animals and humans indicate that the hormone aldosterone impairs NOS activity. For example, in rat models, exogenous aldosterone increases oxidative stress and diminishes endothelium-dependent relaxation to acetylcholine. 2 Increased plasma aldosterone concentrations are associated with decreased arterial compliance in hypertensive individuals. 3 Patients with primary hyperaldosteronism exhibit a greater degree of endothelial dysfunction than do patients with essential hypertension. 4 In patients with congestive heart failure, aldosterone receptor antagonism, but not treatment with amiloride, improves endothelium-dependent vasodilation. 5,6 Although studies evidence an effect of aldosterone on endothelial NOS (eNOS) activity in humans, the converse possibility that NOS activity influences aldosterone synthesis has not been studied extensively in humans. In vitro, NO inhibits angiotensin II (Ang II) and adrenocorticotropic hormone (corticotropin [ACTH])-stimulated aldosterone secretion from cultured adrenal glomerulosa cells through a cyclic GMP-independent mechanism. 7-9 Aldosterone receptor antagonism reverses cardiovascular injury in rats treated with the NOS inhibitor N G -nitro-L-arginine methyl ester (L-NAME), 10,11 and some 12 but not all 13,14 investigators have reported that circulating aldosterone concentrations are increased in this model. In addition, short-term local inhibition of NOS by adrenal arterial infusion of L-NAME increases basal aldosterone secretion in conscious sheep. 15 The present s...