Objective To evaluate whether the clustering of risk factors, both environmental and genetic, increases the risk of essential hypertension (EH) and the accumulation of risk factors influences the blood pressure level in normotensives. Methods On the basis of a prevalence survey, 501 subjects of Mongolian ethnicity (243 hypertensives and 258 normotensives) who were not related to each other were selected to conduct a case-control study. All subjects were interviewed with questionnaires and their blood specimens were collected. Renin gene insertion/deletion (I/D) polymorphism, a new genetic marker, was genotyped with PCR and polyacrylamide gel electrophoresis. Results Overweight, alcohol consumption, and renin gene I/D polymorphism were significant risk factors of EH (P<0.05). The odds ratios (OR) for the number of risk factors were 2.39 (95%CI: 0.98-6.74) for one risk factor, 5.03 (95%CI: 2.06-14.18) for two, and 6.09 (95%CI: 1.85-22.38) for three respectively after adjusting for age and sex. In normotensives, age- and sex-adjusted mean blood pressures increased with more accumulation of risk factors. However, there were no significant differences among the different blood pressure levels according to the number of risk factors (P>0.05). Conclusion Overweight, alcohol consumption, and renin gene I/D polymorphism are risk factors of EH in the Mongolian ethnic population of China. The accumulation of the risk factors causes a sharp increase of the risk of EH. Objective To evaluate whether the clustering of risk factors, both environmental and genetic, increases the risk of essential hypertension (EH) and the accumulation of risk factors influences the blood pressure level in normotensives. Methods On the basis of a prevalence survey, 501 subjects of All subjects were interviewed with questionnaires and their blood specimens were collected. Renin gene insertion / deletion (I / D) polymorphism , a new genetic marker, was genotyped with PCR and polyacrylamide gel electrophoresis. Results Overweight, alcohol consumption, and renin gene I / D polymorphism were significant risk factors of EH (P <0.05). The odds ratios (OR) for the number of risk factors were 2.39 (95% CI: 0.98-6.74) for one risk factor 5.03 (95% CI 2.06-14.18) for two and 6.09 (95% CI 1.85-22.38) for three respectively after adjusting for an an However, there were no significant differences among the different blood pressure levels according to the number of risk factors (P> 0.05). Conclusion Overweight, alcohol consumption, and renin gene I / D polymorphism are risk factors of EH in the Mongolian ethnic population of China. The accumulation of the risk factors causes a sharp increase of the risk of EH.