Data concerning hyperinsulinemia/insulin resistance in the pathogenesis of essential hypertension are presented. Approximately 50% of hypertensive patients have insulin resistance. The prime site of insulin resistance is in the skeletal muscle affecting non oxidative glucose metabolism (glycogen synthesis). Effects of insulin on the kidney points toward possible, but not the key role of the hyperinsulinemia in the pathogenesis of arterial hypertension. According to some results hypertension causes hyperinsulinemia/insulin resistance through hemodynamic alterations and structural changes of blood vessels. On the other hand, there is no hyperinsulinemia in the secondary forms of arterial hypertension. This is an argument against hypertension as a prime cause in insulin resistance inception. The importance of metabolic alterations of lipid status and fibrinolytic system in patients with hyperinsulinemia has been emphasized. These metabolic changes increase cardiovascular risk. Effects of antihypertensive drugs on glucose metabolism and insulin sensitivity are reported. In conclusion, hyperinsulinemia per se is not a risk factor. However, when connected with other metabolic disturbances (dyslipidemia, hypertension, hyperuricemia, disorders of fibrinolysis) it increases the risk of cardiovascular diseases.