We studied 70 Hong Kong Chinese patients with untreated hypertension and 47 normotensive controls. Blood pressure measurements and 24-h urine collection were performed for each patient, and were repeated 12 weeks later in 14 hypertensive patients who remained untreated. Twenty-two hypertensive patients underwent ambulatory blood pressure monitoring. The primary hypothesis tested was a correlation between diastolic blood pressure and 24-h urinary sodium excretion. In the hypertensive patients, diastolic blood pressure correlated with 24-h urinary sodium excretion (r = 0.41, p < 0.001), even after adjustment for age, gender, body mass index, ethanol intake and season (r = 0.34, p = 0.02). In normotensive controls, diastolic blood pressure did not correlate with sodium excretion (r = 0.21, p = 0.16). A correlation between diastolic blood pressure and sodium excretion was also observed in the patients who underwent ambulatory blood pressure monitoring (r = 0.47, p = 0.026), and in repeat measurements in untreated patients (r = 0.60, p = 0.02). systolic blood pressure did not correlate with sodium excretion, although if increased with patient age (0.6 +/- 0.1 mmHg/year, p < 0.001). In a multiple regression analysis with diastolic blood pressure as the dependent variable, the regression coefficient was 0.06 +/- 0.02 mmHg/mmol Na. The regression coefficients for ambulatory diastolic blood pressure and diastolic pressure repeated at 12 weeks were 0.07 +/- 0.03 and 0.09 +/- 0.04 mmHg/mmol Na, respectively. Urinary sodium excretion was related to diastolic blood pressure in our hypertensive patients, accounting for 17% of the variance of diastolic blood pressure.