The geriatric population is growing in number and along with it, the prevalence of hypertension (HTN). The elderly have a unique set of characteristics that must be taken into account when treating this condition. Not only is it widespread, but its consequences, mainly cardiovascular and cerebrovascular, are devastating. Because the elderly have multiple comorbid concomitant conditions, the practitioner must be cognizant of polypharmacy and resistant HTN and prescribe in a safe fashion conducive to compliance and efficacy. Treatment in even the oldest old is indicated. Function and quality of life should be the driving principles when managing the elderly, be they in the ambulatory or long-term care setting.