To determine whether Na/Ca exchange is altered in primary hypertension, Na-dependent changes in intracellular Ca, ([Ca] i), were measured in isolated perfused hearts from Wistar–Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Intracellular Na, (Na i, mEq/kg dry wt), and [Ca] i were measured by NMR spectroscopy. Control [Ca] i was less in WKY than SHR (176±18 vs 253±21 nmol/l; mean±S.E., P<0.05), whereas Na i was not significantly different. One explanation for this is that net Na/Ca exchange flux is decreased in SHR. If this hypothesis is correct, the rate of Ca uptake in SHR should be less than WKY when Na/Ca exchange is reversed by decreasing the transmembrane Na gradient. The Na gradient was reduced by decreasing extracellular Na, ([Na] o) and/or by increasing [Na] i. To increase [Na] i, Na uptake was stimulated by acidification while Na extrusion by Na/K ATPase was inhibited by K-free perfusion. Seventeen minutes after acidification, Na i had increased but was not significantly different in SHR and WKY (18.0±2.3 to 57.4±7.6 vs 20.3±0.6 to 66.5±4.8 mEq/kg dry wt, respectively). Yet [Ca] i was greater in WKY than SHR (1768±142 vs 1201±90 nmol/l; P<0.05). [Ca] i was also measured after decreasing [Na] o from 141 to 30 mmol/l. Fifteen minutes after reducing [Na] o, [Ca] i was greater in WKY than SHR (833±119 vs 425±94 nmol/l; P<0.05). Thus for both protocols, decreasing the transmembrane Na gradient led to increased [Ca] i in both SHR and WKY, but less increase in SHR. The results are consistent with the hypothesis that Na/Ca exchange activity is less in SHR than WKY myocardium.