In a recent meta-analysis of 13 studies of antihypertensive treatment, it was demonstrated that the reduction of risk for coronary artery disease was 14% compared with the 20% to 25% expected for a diastolic blood pressure reduction of 5 to 6 mm Hg according to observational studies. In contrast, the obtained effect on stroke reduction was of the same order as that expected for a given blood pressure reduction. A meta-analysis of 22 lipid-lowering studies indicated a reduction in risk of coronary artery disease that is consistent with epidemiologic observations, indicating a difference in risk of 20% to 30% for a 10% difference in cholesterol concentration. Many cross-sectional studies have demonstrated that hypertensive men and women are metabolically different from normotensive subjects. These differences include a disturbed glucose metabolism due to insulin resistance that may also be the basis of the observed lipid abnormalities and even of the hypertension itself. Some of the drugs used in the treatment of hypertension produce changes in metabolism such that insulin resistance becomes worse and lipid abnormalities become still more pronounced. In the case of treatment with beta-blockers, there is a change in lipoprotein composition that may indicate an increased tendency toward oxidation, which may render the lipoproteins more atherogenic. It is obvious that the metabolic profile in hypertensive patients warrants consideration and, furthermore, that the metabolic effects of different drugs should be taken into account when starting treatment.