Differences in red cell sodium content and sodium-lithium countertransport were studied in black and white children with a mean age of 12 years. For both boys and girls red cell sodium content was higher in blacks and countertransport lower (P less than 0.05). For both ethnic groups red cell sodium was lower in girls than boys and a consistent positive relationship was noted between body mass index and countertransport. Despite the lower red cell Na-Li countertransport values in black compared to white children, a significant positive correlation with systolic blood pressure was found independent of adiposity. In contrast, no correlation was evident between Na-Li countertransport and blood pressure in the white children. If red cell cation transport is confirmed as a marker for hypertension, study of racial differences may help explain the twofold higher prevalence of this disease among blacks.