Arterial hypertension is particularly prevalent in the elderly and treatment is required according to the literature. Treatment in subjects between 65 and 80 years of age resembles by characteristics and results that obtained in younger population. The treatment of arterial hypertension in the very elderly differs in a relevant percentage of them. It is quite similar in those with a good physical fitness with or without cardiovascular disease. A series of factors as the presence of real sustained hypertension, orthostatic hypotension, frailty and disability, and the boundary of safety recommended by international recent guidelines analysed here are relevant to characterize a clearly elevated risk of complications in the remaining very elderly patients.