Nitric oxide, derived from nitric oxide synthase (NOS), plays an important role in regulating sympathetic nerve activity. Neuronal NOS (nNOS) is expressed throughout the central and peripheral nervous system. nNOS has a sympathoinhibitory effect under physiological conditions by acting on different sites of the nervous system, including the paraventricular nucleus, the nucleus of the solitary tract, the rostral ventrolateral medulla, the carotid body and nerves in the kidney. nNOS is sympathoinhibitory in a range of diseases including chronic heart failure, chronic renal failure, hypertension and diabetes. nNOS is believed to mediate sympathoinhibitory effects induced by a range of signaling pathways including those promoted by angiotensin-converting enzyme 2 over-expression; statin therapy; angiotensin II type 1 receptor blockers; exercise training; tumor necrosis factor-α blockade; superoxide dismutase mimetics; and estrogen replacement therapy. Increase in nNOS can increase sympathoinhibitory γ-aminobutyric acid activity and decrease sympathoexcitatory angiotensin II signaling and glutamate activity. nNOS may have sympathoexcitatory effects in some circumstances such as chronic heart failure induced by prolonged high salt treatment. The effectiveness of nNOS upregulation in treating sympathetic overactive conditions including chronic heart failure needs to be further investigated.