Abstract-Dopamine receptors type 2 (D2)-like receptor blockers cause an increase in the norepinephrine response to intense physical exercise. However, during intense physical exercise, D2-like antagonists also cause an increase in the epinephrine response, which itself might cause an increase in plasma norepinephrine through the activation of 2 presynaptic receptors. Therefore, we evaluated the effect of domperidone, a D2-like antagonist, on the norepinephrine response to physical exercise in 6 Addison patients (3 were adrenalectomized and 3 had adrenal tuberculosis). In these patients, the norepinephrine increase observed during exercise was significantly higher after the administration of domperidone than a placebo (Fϭ4,328; PϽ0.001). Because peripheral plasma norepinephrine does not reflect the sympathetic tone to the heart accurately, we evaluated the effect of domperidone administration (20 mg orally) on the sympathovagal balance, which was measured by the ratio between the high-and low-frequency components of heart rate variability, in 9 normal volunteers in the supine and sitting positions. When compared with placebo, domperidone caused a significant increase in the low/high frequency ratio (PϽ0.05) in the sitting position without modifying basal and stimulated norepinephrine plasma levels or blood pressure. These data support a role for endogenous dopamine in modulating norepinephrine release by human sympathetic nerves in vivo. (Hypertension. 1999;34:398-402.)Key Words: dopamine Ⅲ plasma Ⅲ norepinephrine Ⅲ heart N euronal dopamine receptors are widely distributed in the central 1 and the peripheral nervous system 2 at different levels. 3 In vitro 4,5 and in vivo 6,7 studies have clearly demonstrated that the activation of these receptors leads to a decrease in catecholamine release. Whether endogenous dopamine plays a modulatory role on sympathetic nerve terminals through these receptors was investigated with Dopamine receptors type 2 (D2)-like receptor antagonists.In previous studies, we demonstrated that D2-like antagonists do not modify plasma norepinephrine (NE) in humans when administered in conditions of rest or mild sympathetic stimulation, which is achieved by standing, a cold pressor test, or hand-grip. 8 During intense sympathetic activation, as induced by physical exercise performed up to 80% of maximal oxygen consumption (V O 2 max), D2-like antagonists cause a larger increase in plasma NE than placebo. 9 These data suggest that during a high degree of sympathetic stimulation, endogenous dopamine, which is coreleased by nerve endings, increases in the synaptic cleft to a level sufficient to modulate and inhibit NE release.However, during a high degree of sympathetic stimulation, the inhibition of D2-like receptors located in the chromaffin cells of the adrenal medulla also causes an increase in plasma epinephrine. 9 Therefore, the greater increase of plasma NE observed during intense physical exercise in subjects receiving domperidone (DMP), a D2-like receptor antagonist, could be due, at l...