Abstract-Impaired endothelial function caused by decreased NO production plays a pathophysiologic role in essential hypertension. Although cross-sectional data are available on the association between endothelial NO synthase gene polymorphisms and hypertension, whether the gene variants and their haplotypes affect the long-term cumulative burden and trend of blood pressure since childhood is not known. This aspect was examined using 4 polymorphisms and a community-based longitudinal cohort of 347 blacks and 801 whites aged 18 to 45 years who have been examined serially 4 to 13 times (7705 observations) over an on average of 23.4 years. The area under the curve calculated using a growth curve of serial measurements of mean arterial pressure was used as a long-term cumulative burden. Blacks compared with whites displayed significantly lower frequencies of the rare alleles for G894T (0.112 versus 0.325), G10T (0.209 versus 0.323), T-786C (0.147 versus 0.372), and A-922G (0.131 versus 0.355). In addition, T-786C and A-922G polymorphisms were in complete linkage disequilibrium in both races. After adjusting for age and body mass index, the 894T and 10T alleles were significantly associated with lower long-term burden of blood pressure since childhood in black females and white females, respectively. With respect to haplotypes, the G894-10T carriers compared with (G894-G10)/(G894-G10) showed significantly lower long-term burden and trend of blood pressure in white females. In conclusion, the endothelial NO synthase gene influences the long-term burden and trend of blood pressure since childhood in females and may contribute to their predisposition to hypertension. The gene encoding endothelial NO synthase (eNOS), which has 26 exons and spans Ϸ22 kb of the genome, maps to chromosome 7q35-7q36. 5 In humans, several sequence variants in the promoter region, exons and introns, have been identified. 5,6 Of these variants, A-922G and T-786C are located in the promoter region: G894T in exon 7, and G10T in intron 23. Although the relationship between endothelial NO production and blood pressure has been studied extensively, information on the association of the eNOS gene variants and their haplotypes with blood pressure is limited and conflicting. [7][8][9][10][11][12][13] Moreover, association studies on the eNOS gene and blood pressure have been so far cross-sectional in nature.Blood pressure increases with age at different rates 14,15 and has a large variability over time, including inherent physiological fluctuations and measurement errors. 16 In addition to the levels at a specific time point, genes may affect the longitudinal trends of blood pressure determined by within-person variability. A substantial genetic contribution to changes in blood pressure over time has been demonstrated in longitudinal twin and family studies. 17,18 Further, using serial measurements of a trait at multiple time points dilutes the measurement errors and minimizes the short-term fluctuations. 19,20 This notion is supported by earlier findin...