The different intervention trials in elderly hypertensives are compatible with the hypothesis that hypotensive drug treatment can decrease cardiovascular mortality mainly by decreasing cerebrovascular mortality. A decrease in the fatal and nonfatal cardiovascular event rate is mainly due to a decrease in cerebrovascular events. It is not established whether hypotensive drug treatment is advisable in symptomless patients with isolated systolic hypertension and in patients with uncomplicated hypertension above age 80. A sudden reduction in blood pressure should be avoided, but whether a progressive reduction of systolic blood pressure below 140 mmHg and of diastolic blood pressure below 85 mmHg is dangerous or advantageous remains to be established.