To date only a small number of studies have investigated the pattern of associations within a set of hypertension risks. The objective of this study was therefore to examine the interrelation of main hypertension risks in an African population by using factor analysis in order to detect underlying risk patterns. Subjects aged 16-70 years (N=963) were recruited from 37 randomly selected sites throughout the North West Province during 1996-1998. Exclusion criteria were pregnancy, lactation, casual visitors, drunkenness and treatment for chronic diseases, such as hypertension. Subjects with blood pressures exceeding 140/90 mmHg were classified as hypertensive. Children aged 10-15 years were also recruited from 30 randomly selected schools during 2000-2001 (N=694). Children were classified as hypertensive when an average systolic or diastolic blood pressure greater than or equal to the 90th percentile for age and sex was encountered, while correcting for height. The following hypertension risks were measured: urbanisation, obesity, plasma fibrinogen, lipids, insulin, serum gamma glutamyl-transferase, dietary intake, smoking and alcohol consumption. From 23 risks the factor analysis disclosed five factors that explained 56.2% of the variance in the male and 43.5% of the variance in the female group: an urban malnutritional phenomenon, the metabolic syndrome X, a hypercholesterolaemic and obesity complex, an alcoholic hypertriglyceridaemia, and central and peripheral cardiovascular hypertensive effects. In conclusion, South Africans migrating from rural to urban areas adapt to a new lifestyle with numerous risks, resulting in conditions like malnutrition, the metabolic syndrome X, dyslipidaemia, alcoholism, obesity and increased peripheral vascular resistance. For successful prevention of hypertension in a population in transition, a whole risk pattern should be corrected, rather than an individual risk by implementing lifestyle modification programmes.