Hypertension, especially that characterized by elevated systolic blood pressure (SBP), greatly increases cardiovascular risk in older persons; controlled trials have demonstrated that antihypertensive drug treatment is effective in lowering cardiovascular events and mortality in this population. Lifestyle modifications may be effective in reducing blood pressure (BP), but medication is usually necessary in the majority of patients. The goal of therapy is a BP of less than 140/90 mm Hg for most patients and less than 130/85 mm Hg for diabetics. Achieving these levels is, however, difficult in many patients over the age of 65 years. In most older hypertensive patients, low dose diuretics or diuretic based therapy should be considered as initial treatment. Moderately long acting or long acting dihydropyridine calcium antagonists are appropriate in isolated systolic hypertension (ISH) for patients in whom a diuretic is ineffective or poorly tolerated. ACE inhibitors, Ã -blockers, and diuretics will significantly reduce cardiovascular events in older hypertensive diabetic patients. Multiple drug therapy is necessary in the majority of patients. Despite the availability of effective therapy, fewer than 25% of older hypertensive patients are controlled. (c)1999 by Le Jacq Communications, Inc.