The theoretical rationale for the role of environmental stress factors in the development of essential hypertension has been outlined in several studies. Briefly, individuals at increased risk for essential hypertension are more likely than non-risk cohorts to exhibit exaggerated cardiovascular reactivity to environmental stressors. This may be especially true for Blacks compared to whites. Furthermore, individuals at risk for developing essential hypertension who are subjected to more frequent physical and/or sociopsychological stressors may experience frequent feelings of anger and hostility with concomitant exaggerated cardiovascular reactivity. Blacks may experience many of these stressors more frequently than whites. The exaggerated cardiovascular reactivity, in turn, is associated with complex neuroendocrine changes which result in pathophysiological alterations, eventually causing chronic elevated blood pressure. Although this rationale has received some empirical support in animal and human studies, definitive evidence to support an etiologic role of environmental stress factors is still lacking and needs to be tested in a prospective manner.