There remains anxiety about the use of hormone replacement therapy (HRT) in postmenopausal women with hypertension. We therefore conducted a prospective open study of sequential changes in BP in 75 women referred to our hypertension clinic who required HRT for amelioration of menopausal symptoms. There were no significant differences in mean systolic or diastolic BPs following the introduction of HRT over a median follow-up time of 14 months (interquartile range 8-32 months), despite a significant rise in mean body weight for individual patients which was statistically significant at three, nine and 12 months following the introduction of HRT. No differences in BP were seen in relation to type of menopause, ethnic origin, history of previous pregnancy-induced hypertension or the type of HRT preparation used. Our data suggest that HRT is safe in hypertensive women who should not therefore be denied this therapy if they have menopausal symptoms, although careful supervision is necessary.