Hypertension and atherosclerosis are the two leading causes of cardiovascular morbidity and mortality. They often coexist in individual patients and one may cause and/or aggravate the other. In recent years a widespread application of molecular biology techniques has led to identification of genetic polymorphisms associated with hypertension and cardiovascular events. Several clinical studies have begun to unravel the pathophysiologic diversity of hypertensive patients as well as the heterogeneity of their cardiovascular disease. A number of peptide growth factors, which through paracrine and autocrine mechanisms may be involved in vascular remodeling and atherogenesis in hypertensive subjects, have been identified. The endothelium has been found to play a pivotal role in the control of vascular tone. Given its strategical location, it is likely to work as a sensor and transducer, which mediates the atherogenic effect of blood pressure, hemodynamic, and humoral changes. We discuss herein the role of the genetic and endothelial factors in the light of recent knowledge gained on the biology of peptide growth factors.