In the United States, cardiovascular disease (CVD) is the leading killer accounting for about 1 million fatalities annually, with hypertension being a major risk factor for stroke, coronary heart disease (CHD), cardiovascular (CV) death, heart failure, and end-stage renal disease--all of which have higher prevalence in African Americans, who also experience greater severity at clinical presentation. In numerous randomized trials and meta-analyses, drug therapy for hypertension has been shown to reduce blood pressure by 4-6 millimeters of mercury (mm Hg) with resultant decreases in stroke of 35%-40%, CHD of 20%-25%, and CV death of about 25%. Cardiovascular drug therapies of proven benefit, including diuretics, angiotensin converting enzyme (ACE inhibitors), and beta-blockers, are safe and effective, alone and in combination. Since African Americans with hypertension tend to have a more severe presentation, they will be even more likely to require multiple drug therapies, which also will include diuretics and calcium channel blockers. Effective strategies to encourage widespread use of these therapies of proven benefit would provide progress toward decreasing the adverse mortality experiences, especially CVD, among African Americans.