The effective treatment of hypertension still poses many problems. In the last decade it has become apparent that in many patients multi-drug regimens are needed to effect blood pressure control. How best to combine medications and what might be a preferred order of initiating drugs is still open to debate and has proven the substance of many of the published guidelines on this theme. Like most matters in the clinical sector the approach to a disease in this case hypertension should remain highly individualised and cognisant of what can be significant cost considerations.