Hypertension is a common problem in the elderly. Its prevalence is currently 60%-80%, but it is estimated that it will increase with the projected population growth of older people aged more than 65 years. Hypertension is a major cardiovascular risk factor due to the well-known continuous relationship between high blood pressure, stroke and cardiovascular (CV) mortality in all age groups. Because of the expected increasing proportion of older people, a further increase in CV and renal complications of hypertension in the next few decades can be predicted. In the elderly, systolic blood pressure increases because of arterial stiffness produced by structural alterations of arterial wall occurring with aging. On the other hand, in people aged 60 years and over, diastolic blood pressure remains unchanged or decreases. Isolated systolic hypertension and high pulse pressure are thus prevalent, and are important risk factors for stroke, coronary heart disease and all-cause mortality in the elderly and very elderly. The efficacy of therapy in older patients with systolic and diastolic hypertension or with isolated systolic hypertension, in terms of reduction of cardiovascular morbility and mortality, have been widely confirmed by many controlled and randomized clinical trials.