BACKGROUND: Few studies have examined the association between a combination of lifestyle factors and the incidence of hypertension, particularly among men. This is important as lifestyle factors are often interrelated, and may often occur in combination. Thus, we investigated the individual and combined effects of body mass index (BMI), smoking status, alcohol intake, physical activity (PA), and cardiorespiratory fitness (CRF) on the incidence of hypertension in men. METHODS: A total of 14,568 men (mean age = 44.0 + or - 9.3 years) from the Aerobics Center Longitudinal Study (ACLS) initially free of hypertension completed an extensive baseline examination during 1974-2003, and were followed for the incidence of hypertension. RESULTS: A total of 1,959 men reported having hypertension during a mean of 10.7 + or - 7.6 years of follow-up. Our data indicated that a combination of five protective health factors significantly reduced the risk of hypertension by 47% (95% confidence interval (CI): 36-56%). We also found that whether all participants in our sample had five protective health factors, the incidence of hypertension would be expected to decrease by 29% (95% CI: 26-31%). Additionally, having a normal BMI and being a nonsmoker and physically fit were significantly and independently associated with a lower risk of developing hypertension. CONCLUSIONS: Our results show that among men aged 20-82 years, a healthy lifestyle can significantly reduce the risk of developing hypertension, and should be considered for the prevention of this chronic condition.