To assess the pathophysiological role of prostacyclin in essential hypertension, plasma levels of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), a stable, nonenzymatic metabolite of prostacyclin, were assayed in 25 patients with essential hypertension and 25 age-matched normotensive subjects. Supine plasma levels of 6-keto-PGF1 alpha were 270 +/- 14 (SE) in normotensive subjects and 203 +/- 14 pg/ml in the patients with essential hypertension. The difference was statistically significant (p less than 0.001). There was a significant negative correlation between plasma levels of 6-keto-PGF1 alpha and systolic blood pressure (r = 0.44, P less than 0.002), diastolic blood pressure (r = 0.55, p less than 0.001), or mean blood pressure (r = 0.56, p less than 0.001) in the pooled subjects. The same relationship was found in the hypertensive patients. There was no definite relationship either between plasma levels of 6-keto-PGF1 alpha and plasma renin activity (PRA) in the supine position, or between changes in plasma levels of 6-keto-PGF1 alpha and changes in PRA after 60 min of upright posture. These results indicate that circulating prostacyclin is reduced in patients with essential hypertension as compared to normotensive subjects. This reduction of plasma prostacyclin may participate, in part, in the maintenance of blood pressure elevation in patients with essential hypertension. It is also suggested that upright posture is not sufficient to elevate circulating prostacyclin.