The natural rise in systolic blood pressure with age is often complicated by other co-morbidities. Pharmacokinetics and pharmacodynamics of antihypertensive drugs are altered during aging, resulting in decrease in absorption and function of the kidney and liver, as well as interactions and adverse reactions of antihypertensives with the often large number of medications taken by the elderly. The problem of compliance in the elderly that may be disrupted by depression, loss of memory, vascular dementia and other conditions that compromise cognition is also of concern. Despite the many issues facing healthcare providers in managing hypertension in the elderly, the benefits are extensively documented and warrant overcoming therapeutic inertia, especially in view of current access to well documented therapeutic options.