Cytochrome P450 4F2 (CYP4F2) catalyzes the -hydroxylation of arachidonic acid to 20-hydroxyeicosatetraenoic acid (20-HETE), a natriuretic and vasoactive eicosanoid that participates in the development of hypertension. The relationship among CYP4F2 genetic variants in the regulatory region, formation of renal 20-HETE, and hypertension is unknown. Here are reported seven genetic variants around the CYP4F2 intronic regulatory region. Four of these variants made up two common haplotypes, Hap I (c.Ϫ91T/c.Ϫ48G/c.Ϫ13T/c.ϩ34T) and Hap II (c.Ϫ91C/c.Ϫ48C/c.Ϫ13C/c.ϩ34G). Hap I included a major functional variant, c.Ϫ91T3 C, which was identified by reporter assay and electrophoretic mobility shift assay. Transfected into HEK293 cells, the Hap I construct showed a trend toward higher basal transcriptional activity and exhibited significantly greater LPS-stimulated activity than Hap II; these findings were the result of different NF-B binding affinity between the two constructs. In vivo, a case-control study demonstrated that homozygosity for Hap I doubled the risk for hypertension in a Chinese population, even after adjustment for risk factors including age, gender, and body mass index. This association was confirmed in a family-based association study. In addition, Hap I was associated with elevated urinary 20-HETE. These results indicate that a functional variant of the CYP4F2 regulatory region, which increases the binding affinity of NF-B, increases the risk for hypertension, likely by modulating the production of 20-HETE. The cytochrome P450 4F2 (CYP4F2) gene, prominently expressed in human kidney and liver, encodes an -hydroxylase that catalyzes the metabolism of arachidonic acid, 1 leukotriene B4, 2 and tocopherol. 3 The 20-hydroxyeicosatetraenoic acid (20-HETE), derived from arachidonic acid by CYP4F2 in the kidney, acts as a natriuretic and vasoactive eicosanoid and plays an important role in the control of renal function and systemic BP. 4,5 Considerable evidence showed that altered renal 20-HETE content and CYP genes were related to hypertension in animal models and in humans 6-10 ; however, the contribution of haplotypes in the CYP4F2 regulatory regiontorenal20-HETEexcretionaswellashumanhypertension remains unclear, because recent investigations indicated that the primary target variants for disease-gene association studies would be located in regulatory regions. 11 Hypertension is a common disease and an independent risk factor for stroke, heart failure, and ESRD. It is widely known that hypertension is a multifactorial disease whereby genetic determinants interact with environmental factors 12 ; however, the molecular mechanisms are still not well understood. Previously, we focused on a single-