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To test the hypothesis that psychosocial factors that are closely related to the behavioural stress process in developing countries have predictive value for the incidence of hypertension.A cohort of 528 African students (220 White, 308 Black), mean ± SD age 22 ± 3.2 years, were followed up for 4 years at the University of Zimbabwe. Baseline measures of selected psychosocial variables such as anxiety, anger, expression, active coping and family instability were made, together with biological and behavioural predictors of hypertension (initial blood pressure, heart rate, body mass, family history of hypertension or diabetes, alcohol intake, smoking and number of years of urbanization). Analyses were stratified by sex and ethnicity.In multivariate analysis Black students had significantly greater baseline anxiety levels and suppressed anger than White students, and Black students who went on to develop hypertension had significantly higher baseline parameters than those who remained normotensive. In multivariate regression analysis, including biological predictors, anxiety, suppressed anger and family instability remained significant independent predictors of hypertension in urbanized Black students. No psychosocial variable alone predicted hypertension in White students in multivariate analyses.Among young, urbanized Black students, besides the well-known genetic (family history of hypertension) and biological (initial blood pressure, heart rate, body mass index, smoking and alcohol intake) predictors of hypertension, psychosocial factors are predictive of the later incidence of hypertension. Behavioural non-pharmacological treatment for hypertension might be considered in African developing countries.