Hypertension is a major cardiovascular risk factor. The commonest mode of death in the elderly is a cardiovascular one and so the treatment of hypertension in the elderly population is an important clinical objective. The choice of which antihypertensive drug to prescribe is expanding and an evidence-based approach should be applied. In recent years more studies have been carried out into the efficacy of the various antihypertensive drugs in the elderly. This review looks at the "hard" outcome data for each major drug class and their suitability for prescribing in the elderly. The differing drug classes are divided into 3 categories based on the weight of evidence supporting them--established, emerging, and add-on therapies. Currently, and until the publication of ongoing trials into newer therapies such as ACE inhibitors and calcium-channel blockers, outcome data suggests that thiazides remain the drug of first choice except where other therapies are indicated for coexistant conditions or more than one drug is required to achieve the desired response.