Hypertension is one of the most important cardiovascular (CV) risk factor, and that lowering blood pressure levels reduces the incidence of CV morbidity and mortality. The higher incidence of hypertension in post-menopausal than in pre-menopausal women raises the attention on the pathophysiological mechanisms potentially involved in post-menopausal ones and outweigh those involved in pre-menopausal women. However, CV disease is one of the leading causes of death in reproductive-age women. Thus, improved awareness, early identification and prompt clinical management of hypertension should be key elements in order to prevent hypertension-related CV morbidity and mortality in pre-menopausal women. However, available data in this specific age group of women are relatively poor and inconsistent, so that the clinical management of young hypertensive women is still debated. The aim of this review is to assess whether there are clear evidences on differences between men and women in epidemiological data, pathophysiological mechanisms, diagnostic options and therapeutic interventions of hypertension and its prognosis, in order to establish the correct approach to this group of hypertensive patients.