Neuropeptide Y (NPY) is coreleased with norepinephrine and stimulates vasoconstriction, vascular and cardiomyocyte hypertrophy via Y1 receptors (R) and angiogenesis via Y2R. Although circulating NPY is elevated in heart failure, NPY's role remains unclear. Activation of the NPY system was determined in Wistar rats with the aortocaval (A-V) fistula model of high-output heart failure. Plasma NPY levels were elevated in A-V fistula animals (115.7 Ϯ 15.3 vs. 63.1 Ϯ 17.4 pM in sham, P Ͻ 0.04). Animals either compensated [urinary Na ϩ excretion returning to normal with moderate disease (COMP)] or remained decompensated with severe cardiac and renal failure (urinary Na ϩ excretion Ͻ0.5 meq/day), increased heart weight, decreased mean arterial pressure and renal blood flow (RBF), and death within 5-7 days (DECOMP). Cardiac and renal tissue NPY decreased with heart failure, proportionate to the severity of renal complications. Cardiac and renal Y1R mRNA expression also decreased (1.5-fold, P Ͻ 0.005) in rats with heart failure. In contrast, Y2R expression increased up to 72-fold in the heart and 5.7-fold in the kidney (P Ͻ 0.001) proportionate to severity of heart failure and cardiac hypertrophy. Changes in receptor expression were confirmed since the Y1R agonist, [Leu31, Pro34]-NPY, had no effect on RBF, whereas the Y2R agonist (13-36)-NPY increased RBF to compensate for disease. Thus, in this model of heart failure, cardiac and renal NPY Y1 receptors decrease and Y2 receptors increase, suggesting an increased effect of NPY on the receptors involved in cardiac remodeling and angiogenesis, and highlighting an important regulatory role of NPY in congestive heart failure. Y1 receptor; Y2 receptor; renal blood flow; cardiac hypertrophy NEUROPEPTIDE Y (NPY) is a 36-amino acid peptide that is colocalized with norepinephrine (NE) in sympathetic nerves innervating the cardiovascular system and is one of the most abundant peptides in the brain and heart (37). It exerts pleiotropic activities, ranging from the regulation of cardiovascular and neuroendocrine functions to the stimulation of food intake and obesity, via the activation of multiple Gi/o protein-coupled receptors (Y1-Y5) (33). Its release is stimulated by severe and prolonged stress and in many pathological conditions (33). Congestive heart failure (CHF) is one of such conditions of severe and chronic stress activation of the sympathetic nervous and endocrine systems. Previous studies showed that NPY plasma levels are elevated in patients with CHF, regardless of the etiology (15,16,28). The increase in plasma NPY during CHF may be significant to the clinical course since NPY plasma concentration appears to be an independent marker for mortality in heart failure patients (27). However, since NPY has multiple effects on the cardiovascular system, the role of NPY in the pathophysiology of CHF is unclear.Studies have demonstrated that the majority of the cardiovascular responses to NPY administration are due to the activation of peripheral Y1 and Y2 receptors. The Y1 recep...