Hypertension has been unequivocally linked to morbid complications such as heart attack, congestive heart failure, renal failure, and stroke. Despite the availability of myriad effective antihypertensive agents, blood pressure remains either untreated or inadequately controlled to even conservative goals in many patients. Only 68.4% of hypertensive individuals are aware of their condition, only 53.6% are under treatment, and nearly 75% fail to reach the recommended target pressure of 140/90 mm Hg. Significantly, only 40 to 50% of hypertensives will be controlled on a single agent, while most patients with more severe hypertension will require 3 or even 4 agents. This article reviews the overall approach to the hypertensive patient, with special emphasis on target blood pressures in special populations and problems frequently encountered in the older patient.