From what is reported in the current literature, the 'metabolic syndrome' is believed to exist and flourish. Most also believe that the metabolic syndrome confers a cardiovascular risk well above the risk attributable to each of its components that are present at a certain time in a specific patient. Is this true and, specifically, is this true in hypertensive patients? Even the definition and the 'diagnosis' of metabolic syndrome are still under debate and very little is known about the average hypertensive patient who is often at high cardiovascular risk. Essential hypertension itself is a complex condition that involves the cardiovascular system, but has deep roots in metabolism and excessive adiposity, especially visceral, intra-abdominal adiposity. Non-optimal blood pressure and hypertension are likely to be the real 'vasculometabolic' syndrome that affects most humans, with the rare exceptions to be found in no-salt, no-fat cultures.