Controlled multicenter clinical trials and almost 50 years of clinical experience have demonstrated incontrovertibly the efficacy, safety, and feasibility of antihypertensive pharmacotherapy. In addition, this vast clinical record has shown, through the intrinsic ability of antihypertensive therapy to control arterial pressure, how to prevent and reverse many of the complications of hypertensive cardiovascular disease affecting the major target organs of the disease (eg, heart, brain, and kidneys). Few questions exist as to which patients should be treated, although some controversy may still exist among authorities as to the selection of specific classes of antihypertensive therapy. Thus, it is now clear that no matter whether systolic or diastolic pressures are elevated (ie, greater than 139 mm Hg or 89 mm Hg, respectively), control of elevated pressure is indicated. One possible and provisional exception to this sweeping statement may relate to patients with borderline isolated systolic hypertension (between 140 and 159 mm Hg, with diastolic pressures less than 90 mm Hg). This discussion concerns the treatment options that are presently available and offers guidelines as to which patients with hypertension may be more suitable for the various classes of agents that are available.