The widespread prevalence of hypertension in the United States and the enormous expense and effort associated with its treatment necessitate a cost-conscious approach to evaluation and therapy. In the past, we have devoted too many resources to testing for rare diseases suspected of causing hypertension when it has been demonstrated that secondary causes are rare. Devoting resources to the effective treatment of essential hypertension itself should be a priority, because such treatment has been shown to reduce morbidity and mortality associated with hypertension and related cardiovascular diseases. Clinical and epidemiologic studies have demonstrated that treatment for hypertension should not be initiated unless diastolic blood pressure readings are 90 mm Hg or greater on three successive office visits. Treatment should be carried out in a step-wise fashion, using a non-pharmacologic approach only in situations in which hypertension is mild, target organ disease is absent, and compliance is favorable. Diuretics should be used as step-one drug therapy in most situations, because they are effective in the majority of patients, convenient to use, easy to titrate, and comparatively inexpensive. They do not cause salt and water retention, and side effects are usually minimal. When the use of diuretics is contraindicated, beta blockers are suitable alternatives, equally effective in most respects. When beta blockers or other non-diuretic drugs are used as step-one therapy and an additional drug is needed, diuretics can be used advantageously in conjunction with the step-one drug.