Abstract-Endothelin-1 (ET-1) is overexpressed in the vascular wall in certain models of experimental hypertension:deoxycorticosterone acetate salt-treated rats, deoxycorticosterone acetate salt-treated spontaneously hypertensive rats (SHR), stroke-prone SHR, Dahl salt-sensitive rats, angiotensin II-infused rats, and 1-kidney 1 clip Goldblatt rats; it is not overexpressed in SHR, 2-kidney 1-clip hypertensive rats, or L-NAME-treated rats. In hypertensive rats without generalized vascular overexpression, however, expression of ET-1 was often enhanced in intramyocardial coronary arteries, suggesting a role of endothelin in myocardial ischemia in hypertension. In rats overexpressing ET-1, ET A/B and ET A -selective receptor antagonists lowered blood pressure and reduced vascular growth, particularly in small arteries, beyond what could be attributed to blood pressure lowering, suggesting a direct effect of ET-1 on growth. Hypertensive rats treated with endothelin antagonists are protected from stroke and renal injury. The ET A/B antagonist bosentan induced blood-pressure reductions in mildly hypertensive patients similar to those achieved with an angiotensinconverting enzyme inhibitor. Moderately to severely hypertensive patients presented with enhanced expression of prepro-ET-1 mRNA in the endothelium of subcutaneous resistance arteries, suggesting that these stages of hypertension may respond particularly well to endothelin antagonism. Hypertensive patients with coronary artery disease have increased arterial expression of ET-1, and increased plasma levels of immunoreactive endothelin have been described in black patients. ET-1 plays an important role in atherosclerosis, for which hypertension is an important risk factor. T he endothelins are potent 21-amino acid vasoconstrictor peptides encoded by 3 genes and produced in many different tissues, particularly the endothelium of blood vessels. 1,2 Endothelin-1 (ET-1), the main endothelin generated in the endothelium, acts in a paracrine or autocrine manner on ET A and ET B receptors on adjacent endothelial or smoothmuscle cells. The genes for ET A and ET B receptors have been cloned. 3,4 ET A and ET B receptors on smooth muscle induce contraction and stimulate proliferation and cell hypertrophy. 5 Endothelial ET B receptors stimulate the production of nitric oxide and prostacyclin and, accordingly, elicit vasorelaxation. 6 It is unclear whether the vasoconstrictor or vasorelaxant action of ET-1 is the predominant physiological effect. This may vary in different vascular beds.Mice in which the ET-1 gene has been inactivated exhibit a slight elevation of blood pressure, 7 which may result from hypoxemia resulting from the craniofacial developmental abnormalities that occur in this experimental paradigm or it may be an expression of a predominant vasodilator action of ET-1. A recent study evaluated this by using crosses of mice heterozygous for targeted disruption of the ET B receptor (Ϫ/ϩ) with mice homozygous for the piebald mutation of the ET B gene (s/s). 8 The prog...