The effects of insulin on Na(+)-H+ exchange were examined in isolated proximal segments from normotensive Sprague-Dawley (SD) and Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR), with monitoring of rates of intracellular pH change (delta pHi/min) and ethylisopropyl amiloride (EIPA)-suppressible 22Na+ uptakes. A 12-min insulin preincubation was necessary for steady-state 22Na+ uptake and rate of pHi change. Insulin responses were similar for 4-wk (prehypertensive) SHR and WKY tubules; 8- (rising hypertension) and 16-wk (established hypertension) SHR responses were increased (P less than 0.05) 23 and 36% with 10(-6) M insulin, respectively. Insulin-like growth factors (IGF-I, IGF-II; 10(-10)-10(-7) M) had no effect on Na(+)-H+ exchange activity. Incubation with physiological concentrations of insulin in combination with hormones that stimulate Na(+)-H+ exchange (angiotensin II; alpha-adrenoceptor agonists) demonstrated no synergistic increases in SHR or WKY tubules; incubation with hormones that inhibit Na(+)-H+ exchange [parathyroid hormone (PTH), dopamine (DA)] indicated that insulin stimulation was decreased with PTH or DA in WKY segments, but PTH or DA reduction of insulin stimulation was lacking in SHR tubules. In summary, these data indicate a direct stimulation by insulin of Na(+)-H+ exchange in the proximal nephron, indicate an increased responsiveness in SHR compared with WKY tubules, and suggest a modulatory role of insulin with other hormones in regulating proximal nephron Na(+)-H+ exchange.