Hypertension is a syndrome that extends beyond high blood pressure and often includes obesity, insulin resistance, altered lipid metabolism and other risk factors. The clustering of risk factors can place even a patient with a modestly elevated blood pressure at high risk for cardiovascular morbidity and mortality. Many of these risk factors either cause or are associated with endothelial dysfunction, which is implicated in development of atherosclerosis and vascular remodeling. Thus, when evaluating an individual with high blood pressure, the presence of other cardiometabolic risk factors should be sought and treated appropriately.