This is a short and non-comprehensive review of clinical, epidemiological and experimental observations that support the importance of the genetic background in the susceptibility to vascular injury and acute cardiovascular accidents in hypertension. In particular, previous observations suggesting the predictive role of positive family history are discussed. In addition, we introduce data obtained in our laboratory through an experiment based on rat strain crossing. This novel approach may provide a well characterized phenotype that allows gene dissection in hypertension with specific regard to cosegregation with vascular accidents.