Sudden cardiac death constitutes 10-20% of all deaths in the western world. In 75% of the cases a coronary cause is found, and the risk of sudden cardiac death increases with advancing coronary heart disease. Hypertension is one of the main risk factors for coronary disease, and hence also for sudden death. The risk of sudden death is three times higher in patients with moderate hypertension than in normotensives. Compared with the survivors, those who die suddenly have higher blood pressure. In hypertensives, sudden cardiac death constitutes 27-60% of all cardiovascular deaths. This article focuses on hypertension as a risk factor for sudden cardiac death and discusses the options of primary prophylaxis.