Increased blood pressure variability induced by stress might accelerate vascular and other changes leading to essential hypertension. Behavior and environment might chronically elevate sympathetic nervous system tone with damaging cardiovascular consequences. Stressful working conditions, defective anger management and poor interpersonal problem solving skills have been implicated in studies of stress-induced blood pressure increases. These influences may interact with diet and genetic risk to exacerbate pathophysiology. Essential hypertension risk might be reduced by modifying working and living environments and by training young persons at risk to cope with or avoid stressors that elicit defensive over-responding.