The risk of cardiovascular disease in patients with hypertension has decreased dramatically over the last 40 years. This impressive reduction is attributable in part to an increased awareness of the risk related to hypertension, to an emphasis on treatment to lower target blood pressures, and to the development of more effective antihypertensive drugs. Several recent studies have revealed potential blood pressure-independent protective effects of some agents, creating a debate on whether different drug classes actually confer a beneficial effect beyond the effect on blood pressure. Studies are needed to assess the contributions of blood pressure and its components versus blood pressure-independent effects on the reduction of cardiovascular risk.