INTRODUCTION AND OBJECTIVES: To assess prospectively the association between alcohol consumption, including alcoholic beverage preference and days of consumption per week, and the risk of hypertension in a Mediterranean cohort. METHODS: We prospectively followed 9,963 Spanish men and women initially without hypertension. Self-reported and validated data on diet and hypertension diagnoses were collected. RESULTS: During follow-up (median [interquartile range], 4.2 [2.5-6.1] years), 554 incident cases of hypertension were identified over a total of 43,562 person-years. The hazard ratio for hypertension among those who consumed alcohol on >or=5 days per week was 1.28 (95% confidence interval, 0.97-1.7) compared to abstainers. Among those who drank alcohol >or=5 days per week, the hazard ratio for hypertension associated with consuming >or=1 drink per day was 1.45 (95% confidence interval, 1.06-2) compared with abstainers. The consumption of beer or spirits, but not wine, was associated with an increased risk of hypertension. The hazard ratio associated with consuming >0.5 drinks of beer or spirits per day was 1.53 (95% confidence interval, 1.18-1.99) compared with abstainers. In contrast, there was a nonsignificant inverse association between red wine intake and the risk of hypertension. CONCLUSIONS: In this Mediterranean population, the consumption of beer or spirits, but not wine, was associated with a higher risk of developing hypertension. However, the weekly pattern of alcohol consumption did not have a significant impact on the risk of hypertension.