Hypertension is a common problem in elderly people. The actual prevalence is uncertain and depends on the diagnostic methods used. Hypertension is an important factor in the two most common causes of death in elderly patients in the UK: heart disease and stroke. Next to age, hypertension is the most important risk factor for acute stroke and an important risk factor for ischaemic heart disease and cardiac failure. There are well defined methods of diagnosis and guidelines on management such as those issued by the British Hypertension Society (BHS). A new version is in preparation. Several trials have confirmed the benefits of treatment in older patients, particularly in terms of stroke reduction. Since the last review in this journal, in 1994, the most important developments have been the publication of more outcome studies, some of which have used calcium antagonists as first-line treatment. This review again focuses on the over-65 age group. Since there are still insufficient data in older subjects, information from research on younger patients has been included to support arguments for various aspects of management.