Nitric oxide is an important vasodilator formed in many tissues, including the vascular endothelium. Because of the relationship between nitric oxide and basal vascular tone, genes regulating nitric oxide have been suggested as candidate genes involved with the development of hypertension. At least three isoforms of nitric oxide synthase have been identified. Two of the isoforms, endothelial and inducible nitric oxide synthase, may have particular importance in hypertension. The gene coding for endothelial nitric oxide synthase on chromosome 7 has been cloned. Polymorphic dinucleotide repeats within this nitric oxide synthase gene were used to test for linkage to hypertension in 259 hypertensive siblings from 112 Utah hypertensive sibships. The resulting 194 sibpairs shared 108 alleles identical by state compared to the expected 108.1 alleles shared as estimated from CEPH allele frequencies. After weighting for different sibship sizes, there was only a 3.9% excess allele sharing (P = 0.21). Allele sharing in more severe hypertensive sibpairs (either two antihypertensive medications or an unmedicated diastolic blood pressure (BP) of 100 mm Hg or higher) showed a 6% excess over expected sharing of alleles (P = 0.28). There was no difference between male and female sibpair sharing of alleles (5.2% vs 7.8%, respectively, both not significant). Therefore, there was no evidence that the gene for endothelial nitric oxide synthase was linked to hypertension in these sibpairs.