The Spaniard prevailed 7-5, 6-3, 5-7, 4-6, 6-4 in a bruising four hours, 50 minutes over his Russian opponent, who was playing in his first grand slam final at the age of 23.
Creaking to start the fifth, Nadal broke from 40-0 at 2-2 to break open the deciding set. But he had to save a break point in the last game before converting his third match point.
Medvedev came up short in his bid to become the first, first-time men's grand slam winner since Marin Cilic at the 2014 US Open.
But it was still a splendid summer for Medvedev, who played in his fourth straight hard-court final.
A year after the women's final in New York featured controversy, there was some -- though not as much -- Sunday after Nadal was docked first serves twice for taking too long to serve.
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