Background. Lifestyle modifications have the potential to bring blood pressure under control or reduce the need for potentially harmful medications and, most importantly, to prevent high blood pressure from developing. Evaluation of the contribution of primary and secondary prevention efforts requires monitoring risk factors for hypertension among those with and without a history of the condition. Methods. This study in the Minnesota Heart Health Program describes the prevalence of the major lifestyle risk factors for hypertension and other cardiovascular disease. Data are from men and women age 25-74 over a period of about 10 years (1980-1990). The study involved six communities, three received an education intervention, and three were used as comparison groups. Irrespective of observed blood pressure values, risk factor levels and time trends are compared among persons taking antihypertensive medication, persons with a history of hypertension but not currently medicated, and a general population, nonhypertensive group who report they were never told they were hypertensive. Analysis was done at the level of the city rather than the individual and involved a subset of the cross-sectional survey data. Results. Significant differences were found between groups for knowledge about and control of high blood pressure, for body mass index, intent to lose weight, physical activity, sodium and fat intake, and total serum cholesterol level. No differences were found in intent to increase physical activity, in alcohol intake, or smoking prevalence. A group by time interaction was found only for frequent use of table salt and percentage of total kilocalories from fat. Most time trends were significant and in a favorable direction for prevention. Means for all groups indicated failure to meet national recommendations for dietary sodium, percentage of calories from fat, total cholesterol level, smoking, and possibly exercise. Conclusions. Efforts to prevent, treat, and control hypertension will require more intensive intervention. Continued monitoring of the knowledge and behaviors of hypertensives and the general population is needed to inform primary and secondary prevention efforts, especially in more diverse populations than this study represents.