Endothelin, a 21-amino-acid peptide, binds to a specific receptor on vascular smooth muscle cells, thereby inducing vasoconstriction. Although plasma levels are not consistently elevated in hypertension, there is evidence that endothelin has an important role in its pathogenesis. Administration of endothelin antagonists has lowered blood pressure and reduced end-organ damage in some animal models. It has also reduced the cross-sectional area of neointima due both to hypertension and vascular injury. T he endothelium plays a role in regulating vascular resistance by releasing substances that dilate or constrict blood vessels. These substances, endothelins, are a family of peptides having potent vasoconstrictive effects. There are basically three types of endothelin: endothelin-1, endothelin-2, and endothelin-3. They are all formed from precursors (big endothelin) by enzymatic cleavage and are all 21-amino-acid peptides with disulfide bridges (Figure 1). Endothelin-1 and endothelin-2 act on the endothelin-A (ET A ) receptor of smooth muscle to produce a prolonged contraction and vasoconstriction. Endothelin-3 can also induce vasoconstriction by binding to the endothelin-B (ET B ) receptor on smooth muscle, but it also acts on the ET B receptors of endothelial cells, where it can actually have the opposite effect. It has been suggested that, under normal conditions, low concentrations of endothelin stimulate ET B receptors, thus contributing to the release of endothelium-derived relaxing factors. 1 Endothelin-1 is probably the best studied of this family. When administered to animals, endothelin-1 causes severe vasoconstriction. 2 The contraction of vascular smooth muscle produced by endothelin-1 may be mediated by an increase in intracellular calcium, but the details have not been established. 3 Infusion of endothelin-1 into healthy human volunteers resulted in a 2.5-fold increase in plasma endothelin-1 concentration and a rise