Abstract-Although the proinflammatory and profibrotic actions of aldosterone (Aldo) on the vasculature have been reported, the effects and molecular mechanisms of Aldo on endothelial function are yet to be determined. We investigated how Aldo regulates endothelial NO synthase (eNOS) function in human umbilical vein endothelial cells (HUVECs). HUVECs were incubated for 16 hours with Aldo 10 Ϫ7 mol/L. The concentration of reactive oxygen species was estimated by measuring 2Ј,7Ј-dichlorodihydrofluorescein diacetate chemiluminescence. Signal transduction was estimated by Western immunoblots. Real-time RT-PCR was performed to measure expression of transcripts of endogenous GTP cyclohydrolase-1 and components of reduced nicotinamide-adenine dinucleotide phosphate oxidase. To eliminate the possible effect of the glucocorticoid receptor (GR) and to emphasize the role of mineralocorticoid receptor, we used GR small interfering RNA and knocked down GR expression in several experiments. NO output was estimated by intracellular cGMP concentration. Reactive oxygen species production increased significantly in Aldo-treated HUVECs but was abolished by pretreatment with eplerenone. Transcripts of p47 phox were increased by Aldo treatment. Vascular endothelial growth factor-induced eNOS Ser 1177 but not Akt Ser 473 phosphorylation levels were reduced significantly by pretreatment with Aldo. Pretreatment with either eplerenone or okadaic acid restored phosphorylation levels of eNOS Ser 1177 in Aldo-treated cells, suggesting that protein phosphatase 2A was upregulated by Aldo via mineralocorticoid receptor. The decrease in NO output caused by Aldo pretreatment was reversed significantly by 5,6,7,8-tetrahydrobiopterin, GTP cyclohydrolase-1 overexpression, or p47 phox knockdown. These results suggest that Aldo inhibits eNOS function through bimodal mechanisms of 5,6,7,8-tetrahydrobiopterin deficiency and protein phosphatase 2A activation. Key Words: aldosterone Ⅲ nitric oxide synthase A ldosterone (Aldo) is the major hormone controlling sodium reabsorption. Aldo elevates blood pressure as a result of volume expansion after sodium absorption in the renal distal tubules. Whereas this increase in blood pressure has unfavorable effects on the vasculature, patients with primary aldosteronism (PA) have been believed to have a relatively good prognosis, because renin activity is usually suppressed in these patients. However, numerous studies have shown unexpectedly that PA is associated with an increased prevalence of cardiovascular complications, such as aortic dissection, myocardial infarction, or stroke. [1][2][3] In addition, recent clinical trials, the Randomized ALdactone Evaluation Study (RALES) and Eplerenone Post-acute myocardial infarction Heart failure Efficacy and SUrvival Study (EPHESUS), showed that mineralocorticoid receptor (MR) antagonists improved the prognosis of chronic heart failure patients even at doses below the threshold that caused significant renal effects. 4,5 This finding suggested that MR antagonism may have a...