Hypertension in the elderly (persons 60 years of age or older) is a major clinical and public health problem. Blood pressure-related morbidity from cardiovascular disease increases steeply after 50 years of age and, with advancing age, becomes increasingly concentrated among persons with clinical hypertension. The data supporting treatment of all forms of hypertension in the elderly are robust. This review focuses on the rationale for treatment, specific treatment strategies, and age-related hemodynamic and pathophysiologic aberrations in the aged individual with hypertension.