Cardiovascular disease is the leading cause of death worldwide. Hypertension--the leading cause of heart attack, stroke, and kidney failure--occurs in more than 20% of adults in most modern societies. Hypertensive patients have defective sodium metabolism. From childhood throughout adult life most acculturated peoples consume 10 to 20 g of salt daily and have more obesity. Populations with low blood pressure are more active, leaner, and consume a diet low in sodium and high in potassium; however, when members of these groups are exposed to western diets, blood pressure increases with age and hypertension occurs. Drug treatment to control blood pressure prevents deaths. Conservative management, including low-sodium, high-potassium diets, restores normal blood pressure in more than half of hypertensive patients. More information on the cause and mechanisms of this condition is needed, but our primary concern is for improved nutrition and drug treatment to prevent hypertension-related cardiovascular deaths.