Hemodynamic parameters and the Rorschach test were performed on 48 borderline and 64 sustained essential hypertensive patients, and compared with 33 normal subjects. Hemodynamic patterns suggested (1) in borderline hypertensives, a neurogenic hypertension, and (2) in sustained hypertensives, a volume- and renal-mediated hypertension. Repeat hemodynamic determinations were performed on 35 borderline hypertensives after a 47 ± 3-month follow-up survey. The results confirmed that, in the same patient, hypertension was successively neurogenic and volume-mediated. The results of the Rorschach test in the overall hypertensive population pointed to an incapacity to form a structured neurosis because of the lack of a fantasy life, and an inadequacy of the mechanisms of repression of aggressive tendencies. These observations were more marked in sustained hypertensives. In borderline hypertensives, the lack of fantasy life, assessed from kinesthetic perceptions, was highly significant (p < 0.01) and was associated with anxiety and functional symptoms suggesting an increased lability of the autonomic nervous system. In sustained hypertensives, however, there was an inability to express anxiety in a symbolic fashion (p < 0.01). These differences in psychological findings between borderline and sustained hypertensives agree with the difference in hemodynamic patterns. The results suggest that sustained hypertensives have a predominantly somatic issue in place of the psychological conflicts observed in borderline hypertensives.