Abstract-Previous studies in several strains of rats have demonstrated that 35 days of recurrent episodic hypoxia (EH) (7 hours per day), with a fractional concentration of inspired oxygen that produces desaturation equivalent to the recurrent hypoxemia of sleep apnea, results in an 8 to 13 mm Hg persistent increase in diurnal systemic blood pressure (BP). Carotid chemoreceptors and the sympathetic nervous system have been shown to be necessary for development of this BP increase. Both renal artery denervation and adrenal demedullation block the BP response to chronic EH. The present study was undertaken to define further the role of the kidneys and the renin-angiotensin system in this BP increase. Separate groups of male Sprague-Dawley rats had either (1) bilateral renal artery denervation with EH, (2) sham surgery with EH, (3) sham surgery with sham EH (compressed air), (4) EH with losartan, (5) unhandled with losartan, or (6) unhandled. The experimental period lasted 35 days. Both renal-artery denervated and losartan-treated animals showed no BP change or a lowering of BP in response to EH, whereas the sham-operated EH animals showed a progressive, sustained increase in resting room air BP. BP remained at basal levels or fell in unhandled and unhandled losartan-treated animals. Plasma renin activity was elevated 4-fold versus basal levels in EH animals with renal nerves intact but remained at baseline levels in denervated animals. At the end of the experiment, renal tissue catecholamines confirmed renal denervation in those animals. In conclusion, EH causes a progressive increase in BP, mediated in part through renal sympathetic nerve activity that acts to increase renin-angiotensin system activity through angiotensin II type 1 receptors. (Hypertension. 1999;34:309-314.)Key Words: hypoxia Ⅲ blood pressure Ⅲ denervation, renal Ⅲ sympathetic nervous system Ⅲ sleep apnea syndromes Ⅲ hypertension, systemic Ⅲ renin-angiotensin system R ecent publications have implicated increased sympathetic nervous system activity, driven by chemoreceptor response to progressive hypoxemia, as a contributing cause of acute elevation of blood pressure (BP) in patients with obstructive sleep apnea. 1-3 The mechanism for sustained diurnal rise in BP after many years of repetitive apnea remains a mystery, but chronic stimuli, including recurrent episodic hypoxia (EH), repeated arousals, or repetitive Mueller maneuvers, may contribute to it.We have developed a rat preparation that mimics the hypoxic changes seen in sleep apnea patients. With the use of individual cylindrical cages and a method for rapid exchange of inspired concentration of oxygen (FiO 2 ) to as low as 2% to 3%, arterial oxyhemoglobin saturation falls acutely to levels of Ϸ70% to 75%. Such EH, when administered repetitively (every 30 seconds for 7 hours per day for 35 days), increases resting, diurnal mean arterial pressure (MAP) by 8 to 13 mm Hg. 4 Chemoreceptor denervated 5 and chemical sympathectomy rats (neurotoxin 6-OH dopamine) 6 show no increase in MAP following...