Patients with primary aldosteronism (PA) were shown to have suppressed muscle sympathetic nerve activity (MSNA) in our previous study. Although baroreflex inhibition probably accounts in part for this reduced MSNA in PA, we hypothesized that the lowered activity of the renin-angiotensin system in PA may also contribute to the suppressed SNA. We recorded MSNA in 9 PA and 16 age-matched normotensive controls (NC). In PA, the resting mean blood pressure (MBP) and serum sodium concentrations were increased, and MSNA was reduced. We examined the effects of infusion of a high physiological dose of ANG II (5.0 ng ⅐ kg Ϫ1 ⅐ min Ϫ1 ) on MSNA in 6 of 9 PA and 9 of 16 NC. Infusion of ANG II caused a greater pressor response in PA than NC, but, in spite of the greater increase in pressure, MSNA increased in PA, whereas it decreased in NC. Simultaneous infusion of nitroprusside and ANG II, to maintain central venous pressure at the baseline level and reduce the elevation in MBP induced by ANG II, caused significantly greater increases in MSNA in PA than in NC. Baroreflex sensitivity of heart rate, estimated during phenylephrine infusions, was reduced in PA, but baroreflex sensitivity of MSNA was unchanged in PA compared with NC. All the abnormalities in PA were eliminated following unilateral adrenalectomy. In conclusion, the suppressed SNA in PA depends in part on the low level of ANG II in these patients.angiotensin II IT IS UNCLEAR WHETHER OR NOT a neurogenic mechanism is involved in the development and maintenance of elevated blood pressure levels in cases of hypertension induced by mineralocorticoid (2,4,5,9,17,26,29,35). Previous studies in rats (2,4,5,29) demonstrated the importance of the sympathetic nervous system or the central nervous system in the pathogenesis of hypertension caused by an excess of mineralocoticoid; central administration of aldosterone caused hypertension in rats (4, 5). However, recent studies in sheep did not support a role of the brain or the sympathetic nervous system in blood pressure elevation induced by the administration of aldosterone (17,35). Some clinical studies have estimated sympathetic nerve activity during the administration of mineralocorticoid (9, 26) or the nerve activity in patients with primary aldosteronism (PA), a type of human mineralocoticoid hypertension (1,8,18,20). Previous clinical studies, including a direct recording of sympathetic nerve activity in our previous study (18) and power spectral analysis of blood pressure (20), suggested a decrease in sympathetic nerve activity in PA patients. However, no studies on directly recorded sympathetic nerve activity in PA patients exist, or the mechanisms of the abnormality of nerve activity in PA were not clarified.Circulating ANG II has been reported to increase sympathetic nerve activity in animals (24, 27) and humans (11,14). Previous animal studies suggest that ANG II stimulates sympathetic nerve activity via sympathetic ganglia (3, 10, 11) and the central nervous system (24, 27). In our previous human studies with norm...