Abstract-We previously found that chronic exogenous hyperinsulinemia without sugar supplementation does not elevate blood pressure. This may be partially explained by the ability of insulin to release nitric oxide and cause vasodilatation.To test this hypothesis, we studied 4 groups of rats: 9 rats (body weight, 213Ϯ14 g) treated with a gradual increase of a sustained-release subcutaneous insulin pellet; 9 rats (body weight, 213Ϯ9 g) treated with N G -nitro-L-arginine methyl ester (L-NAME) in drinking water 50 mg/L; 19 rats (body weight, 217Ϯ11 g) treated with the combination of L-NAME and insulin; and 9 control rats (body weight, 218Ϯ11 g). Blood pressure was followed weekly for 6 weeks, and then rats were studied in metabolic cages. Weight gain was not different during the 6 weeks. Renal function did not differ between the 4 groups, but 24-hour urinary nitrite/nitrate excretion was lower (PϽ0.02) in L-NAME-treated and higher in insulin-treated rats. Plasma insulin doubled (PϽ0.002) in the insulin-treated rats, but there was no hypoglycemia and, by week 6, fructosamine levels were 2.1Ϯ0.2, 2.1Ϯ0.2, 2.3Ϯ0.1, and 2.3Ϯ0.2 mmol/L in control rats and rats treated with L-NAME, insulin, and L-NAME plus insulin, respectively. Systolic blood pressure, which did not differ at baseline, at week 3 was 122Ϯ17, 118Ϯ17, and 118Ϯ24 mm Hg in the control, L-NAME, and insulin groups and 136Ϯ14 mm Hg (PϽ0.03) in the combination group. At week 6, systolic blood pressure was 128Ϯ14, 127Ϯ15, and 118Ϯ13 mm Hg in the control, L-NAME, and insulin groups, respectively, and 150Ϯ14 mm Hg (PϽ0.0005) in the combination group. In a subsequent experiment, L-arginine 2 g/L abrogated the effects of L-NAME and insulin combination. In conclusion, chronic exogenous hyperinsulinemia does not affect blood pressure but may cause hypertension when endothelial function is compromised. Key Words: insulin Ⅲ nitric oxide Ⅲ sodium Ⅲ nitrites Ⅲ nitrates H yperinsulinemia was found to be common in essential hypertension even without obesity and is the foundation for the concept of the metabolic syndrome X. However, the manner in which insulin elevates blood pressure is unclear. Sympathetic activation, 1,2 sodium retention, 3 and vascular hypertrophy have been suggested 4 but never proven in a chronic model of hyperinsulinemia. Indeed, because of the vasodilatory effects of insulin, 2 it has been suggested the vasodilation may mask a prohypertensive effect. More recently it was found that, in part, insulin-induced vasodilation may be related to increase in nitric oxide synthase (NOS) activity. 5 There have been several attempts to produce hypertension in rats by way of chronic exogenous hyperinsulinemia. 6 -10 In most of these studies, increase in carbohydrate consumption (intravenous glucose or oral sucrose) was combined with insulin to prevent hypoglycemia. We previously devised a method for producing chronic exogenous hyperinsulinemia in normal rats, without sugar supplementation and without hypoglycemia, that did not affect blood pressure. 10 However, whe...