Hypertension and end-stage renal disease (ESRD) constitute a major health threat to Puerto Ricans in the United States and in the Commonwealth. In the Hispanic population of the United States, Puerto Ricans seem to have a worse health status than Mexican- and Cuban Americans. Poverty, language, and lack of education increase the risk of less-than-adequate diagnosis and treatment of hypertension. In the Commonwealth, hypertension is a common problem. Deaths caused by heart disease continue to increase on the island. Although the health care system in Puerto Rico continues to improve, changes in diet, increased social stress, and the high prevalence of diabetes mellitus and obesity may add to the increased death rate from cardiovascular causes. The incidence and prevalence of ESRD in Puerto Rico is as high as in the United States; however, diabetes mellitus seems to be the primary diagnosis in a larger number of patients with ESRD than in the U.S. Preventive and control measures must be urgently taken by public health officials to minimize the impact of these disorders in the health of Puerto Ricans.