Coronary artery calcium (CAC) is increased by high blood pressure (BP), predicts new-onset hypertension, and is a powerful predictor of atherosclerotic cardiovascular disease events in patients with and without hypertension. Unlike other diseases (e.g., hypercholesterolemia), the clinical use of CAC scoring to personalize the treatment of high BP has not received much attention and therefore remains less well defined. Herein, we provide an updated review of studies investigating the relationship between CAC and BP. Finally, we propose a clinical algorithm to incorporate CAC into hypertension management, with a focus on its potential value in tailoring the timing of medication therapy and in helping to personalize BP goals.