In the CARDIA (Coronary Artery Risk Development in Young Adults) study,S5.2.4-43 phys- ical fitness measured at 18 to 30 years of age in the upper 2 deciles of an otherwise healthy population was associated with one third the risk of developing hypertension 15 years later, and one half the risk after adjustment for body mass index, as compared with the lowest quintile. Change in fitness assessed 7 years later further modified risk.S5.2.4-43 In a cohort of men 20 to 90 years of age who were followed longitudi- nally for 3 to 28 years, higher physical fitness decreased the rate of rise in SBP over time and delayed the time to onset of The presence of a direct relationship between alcohol consumption and BP was first reported in 1915S5.2.5-45 and has been repeatedly identified in contemporary cross-sec- tional and prospective cohort studies.S5.2.5-46 Estimates of the contribution of alcohol consumption to population incidence and prevalence of hypertension vary according to level of intake. In the United States, it seems likely that alcohol may account for close to 10% of the population burden of hyper- tension (higher in men than in women). In contrast to its detrimental effect on BP, alcohol intake is associated with Figure 3. Screening for secondary hypertension. Colors correspond to Class of Recommendation in Table 1. TOD indicates target organ damage (eg, cerebrovascular disease, hypertensive retinopathy, left ventricular hypertrophy, left ventricular dysfunction, heart failure, coronary artery disease, chronic kidney disease, albuminuria, peripheral artery disease). Table 13. 