Obesity shows a strong association with hypertension, primarily due to secretion of an abundance of para- and endocrine peptides by the visceral adipose tissue that play a key role in the pathogenesis of high blood pressure and are responsible for the accelerated atherothrombosis encountered in overweight individuals. Increased activity of the RAAS and the sympathetic nerve system are the main pathophysiologic factors; hypertension in obese subjects is characterized by increased peripheral arterial resistance, high cardiac output, hypervolemia and salt sensitivity. Medical therapy sees blockade of the RAAS in front. Priority in treatment should be given to improvements in life style, primarily in increasing physical activity and decreasing caloric intake, and to medical treatment of associated risk factors according to the modern concept of global risk management.