To investigate the physiological role of atrial natriuretic factor (ANF) in patients with hypoxic pulmonary hypertension secondary to chronic obstructive lung disease (COLD), we infused synthetic a-human ANF in seven such patients, and investigated the physiological correlates to circulating peptide levels in 24 patients with COLD.ANF infusion, at incremental rates of 0.01, 0.03, and 0.1 Mg/kg . min, increased basal plasma immunoreactive (ir) ANF (136±38 pg/ml) by 3-, 10-, and 26-fold, respectively, and reduced pulmonary artery pressure (from 33±3 to 25±2 mmHg, P < 0.001) and systemic arterial pressure (from 88±4 to 79±4 mmHg, P < 0.001) in a dose-related fashion. Cardiac index increased by 13.5% (P < 0.01) while heart rate was unchanged. Cardiac filling pressures decreased at 0.1 Mg/kg min ANF. Pulmonary and systemic vascular resistance fell by 37% (P < 0.001) and 19% (P < 0.001), respectively. Arterial oxygenation was impaired during ANF infusion, suggesting partial reversal of hypoxic pulmonary vasoconstriction. Plasma renin activity remained unchanged but aldosterone fell by 44% (P < 0.01).The levels of plasma irANF in 24 patients correlated directly with the degree of hemoconcentration (r = 0.67, P < 0.001), respiratory acidosis (r = -0.65, P < 0.001), and pulmonary hypertension (r = 0.52, P < 0.01). The results suggest that ANF may serve as a potent pulmonary vasodilator involved in the circulatory homeostasis of patients with COLD.