In this lecture I intend to discuss the role of blood pressure as a risk factor, recognising the different components of the blood pressure measurement – diastolic, systolic and pulse pressure. I will define what I consider as the high risk phenotype, and point out that there is a paradox around the nature of hypertension in obesity. I will also describe the paradox of salt sensitivity and renin level as cardiovascular risk factors and attempt to resolve these by looking at recent data. The question of treatment will be discussed at some length, and particularly why it might be that treatment of blood pressure, with virtually any agent, is able almost completely to reverse the adverse effects of pressure on coronary heart disease and stroke risk within two to three years. Finally, I will tackle the question of where diabetes fits in, in terms of both risk and treatment.