The importance of hypertension and hyperlipidemia as independent and interactive risk factors for the development of premature cardiovascular disease, and particularly for the development of atherosclerotic coronary heart disease, is becoming increasingly apparent both from epidemiologic data and from therapeutic trials. Nevertheless, therapeutic trials of patients with mild hypertension have not demonstrated benefits from lowering arterial pressure, in terms of reduced mortality rates from coronary events. This may, in part, be due to the fact that many of the antihypertensive agents used in these trials adversely influence lipid and lipoprotein levels. Thus, agents that are lipid-neutral or that favorably influence the lipid profile, such as selective alpha 1-inhibitors, are receiving increasing attention for the treatment of mild hypertension. Recent insights into these issues are considered.