(CH), caused by many lung diseases, results in pulmonary hypertension due, in part, to increased muscularity of small pulmonary vessels. Pulmonary arterial smooth muscle cell (PASMC) proliferation in response to growth factors requires increased intracellular pH (pH i) mediated by activation of Na ϩ /H ϩ exchange (NHE); however, the effect of CH on PASMC pH i homeostasis is unknown. Thus we measured basal pH i and NHE activity and expression in PASMCs isolated from mice exposed to normoxia or CH (3 wk/10% O 2). pHi was measured using the pH-sensitive fluorescent dye BCECF-AM. NHE activity was determined from Na ϩ -dependent recovery from NH 4-induced acidosis, and NHE expression was determined by RT-PCR and immunoblot. PASMCs from chronically hypoxic mice exhibited elevated basal pH i and increased NHE activity. NHE1 was the predominate isoform present in mouse PASMCs, and both gene and protein expression of NHE1 was increased following exposure to CH. Our findings indicate that exposure to CH caused increased pH i, NHE activity, and NHE1 expression, changes that may contribute to the development of pulmonary hypertension, in part, via pH-dependent induction of PASMC proliferation. pulmonary hypertension MANY CHRONIC LUNG DISEASES cause prolonged alveolar hypoxia, resulting in the development of pulmonary hypertension. The elevation in pulmonary arterial pressure is due to both active contraction of vascular smooth muscle and structural remodeling (21,24,36,38). Pulmonary vascular remodeling in response to chronic hypoxia has been well characterized and includes pulmonary arterial smooth muscle cell (PASMC) hypertrophy and hyperplasia, intimal thickening, and extension of smooth muscle into previously nonmuscular arterioles (21, 36). The exact cellular mechanisms governing hypoxia-induced PASMC growth are not completely known; however, changes in intracellular pH (pH i ) have been demonstrated to be required for cell growth and/or proliferation in pulmonary (33) and systemic tissue (6,17,22), suggesting a possible pivotal role for H ϩ homeostasis in mediating this response.