Recognition that cardiovascular risk factors, such as hypertension, dyslipidaemia and diabetes mellitus, often cluster together has focused attention on the concept of total cardiovascular risk. Most current hypertension management guidelines emphasize the importance of assessing and managing the total risk in an individual patient. Due to the presence of additional risk factors, target-organ damage and associated clinical conditions, patients may be at high risk of cardiovascular events even when their blood pressure is normal or high-normal (systolic blood pressure 130-139 mmHg, diastolic blood pressure 80-89 mmHg). Such high-risk patients, although common in clinical practice, are often under-diagnosed. Intensive hypertensive therapy is recommended for high-risk patients. In most cases, this will necessitate combination therapy with two or more drugs. Moreover, antihypertensive therapy should form one component of a multifactorial approach aimed at treating all reversible risk factors. In the future, research should be aimed at controlling or reversing subclinical target-organ damage, the ultimate aim being to prevent the progression of cardiovascular risk in individuals at low or medium risk.