Many large-scale intervention trials performed in Western countries have proven the necessity of treatment of hypertension in the elderly, including isolated systolic hypertension. However, it is still unclear the benefit of antihypertensive treatment in mild hypertensive patients and that in very elderly patients with hypertension. An ongoing clinical trial, the Hypertension in the Very Elderly Trial (HYVET), may clarify whether or not antihypertensive treatment is beneficial in the very elderly. Regarding target blood pressure, there is no clinical study in which average of systolic blood pressure at the end of study decreased lower than 140 mmHg. Regarding the first-line drugs for elderly hypertension, usefulness of diuretics and calcium channel blockers has been demonstrated in studies with placebo control group. Usefulness of inhibitors of the rennin-angiotensin system has been also reported in LIFE substudy and ANBP2. It is still required to perform large scale trials in the elderly hypertension to answer these undissolved problems.