To assess the role of angiotensin II (AII) in the development of myocardial dysfunction during ischemia and reperfusion, the effects of either oral pretreatment with 1 mg/kg losartan or treatment with 4.5 mu M losartan in vitro were compared with effects measured in the respective placebo or in vitro control groups in an isolated rat working-heart model. Both groups treated with losartan showed significant improvement (p < 0.005) in functional recovery following 20 min of ischemia compared with the respective control groups. Coronary flow (CF) and cardiac output (CO) were also significantly increased during reperfusion in the drug treatment groups compared with controls (p < 0.05 to p < 0.001). The recovery of mechanical function, CO, and CF was significantly more rapid in hearts from rats treated orally with losartan than in hearts treated with losartan in vitro. As measured by 31P-nuclear magnetic resonance, the changes observed in ATP levels and in intracellular pH during ischemia and reperfusion were essentially the same under either treatment regimen. This article describes the initial observation of a significant reduction in myocardial dysfunction during reperfusion following 20 min of global ischemia in the isolated perfused heart as a result of acute AII AT1 receptor antagonism by losartan administered either directly in vitro or by oral pretreatment.