Since the last review of hypertension in older patients in this journal in 1999, there has been an enormous expansion in the available evidence for management of hypertension. Blood pressure treatment is only one part in an overall strategy of cardiovascular risk reduction. The actual prevalence of hypertension depends on the level of blood pressure used to define when treatment should be started and thus varies between patients depending on their degree of risk. A publication from the University of York NHS Centre for Reviews and Dissemination quoted a figure of over 50% of older people as being hypertensive in 1999. Newer guidelines tend to be encouraging treatment at lower blood pressure levels than previously and some authors now suggest that around 70% of the elderly population could be considered as hypertensive.