BACKGROUND The recommended maximum water temperature for public hot tubs has been set at 40.0 degrees C, but no research has been published on human immersion in hot water at higher temperatures. OBJECTIVE We hypothesized that thermoregulatory and cardiovascular responses at two water temperatures would be proportional to the water:blood temperature gradients. METHODS Six healthy men were immersed for 21 min in circulating hot water at 40.0 and 41.5 degrees C in separate trials in random order 1-3 wk apart. Measurements included heart rate, systolic BP, esophageal, rectal, and non-immersed skin temperatures, sweat rate, and perceived comfort. RESULTS The rise in all body temperatures, sweat rate, and heart rate were significantly greater in the 41.5 vs. 40.0 degrees C water. Peak esophageal temperatures were 38.3 +/- 0.2 degrees C vs. 37.8 +/- 0.03 degrees C, peak sweat rates were 0.48 +/- 0.05 vs. 0.32 +/- 0.03 kg x m(-2) x h(-1), and peak heart rates were 123 +/- 7 vs. 108 +/- 5 bpm, respectively. Systolic BPs followed different patterns of response in each trial, whereas diastolic pressures were not different between trials. Comfort at each level of immersion was reduced during the 41.5 degrees C trial compared with the 40.0 degrees C in excess of that predicted by difference in esophageal temperature between the trials. CONCLUSIONS These results suggest that risks of hyperthermia or adverse cardiovascular effects in hot tubs may not be greater in water above 40.0 degrees C unless perceptual judgment is impaired. Hypotension when standing to exit the tub occurred in both trials and may represent a potential hazard to hot tub use.