Cardiovascular disease is the second leading cause of death in Japan. The macronutrient-to-energy intake ratio of the typical Japanese diet is ideal. The high consumption of fish, which is associated with a high intake of n-3 polyunsaturated fatty acids, is a specific feature of the Japanese diet. However, the Japanese diet is high in salt, which is associated with a high prevalence of hypertension, a major risk factor for CVD. Therefore, from the past to the present, a key strategy to prevent CVD in Japan has been the management of hypertension. In Japan, a population approach, that is, Health Japan 21, and a high-risk approach, that is, Specific Health Checkups and Specific Health Guidance Programme, are being implemented for CVD prevention based on epidemiologic evidence. Although the population approach focuses on the prevention of hypertension, the current high-risk approach also focuses on the prevention of visceral obesity. As a result, prevention programs specific to hypertension, such as reducing salt intake, are somewhat weak, and the program needs to be revised.