Systolic blood pressure is higher in African American and Hispanic women older than 60 and in white women older than 70 than it is in men. Coupled with their longer survival, elderly women have higher hypertension prevalence rates, particularly for isolated systolic hypertension. Hemodynamic characteristics differ by sex for premenopausal women and age-matched men, but these differences lessen after menopause. This transition may result from hormonal or metabolic alterations, including weight gain and tissue adiposity, which are common after menopause. Clinical trials enrolling large numbers of women support the benefits of treatment to reduce cardiovascular events and mortality. The trend to enroll subjects with several comorbidities and thereby increase event rates may limit the applicability of trial results to healthier women. Women appear more prone to develop side effects from antihypertensive medications and may metabolize these agents differently. There is a need for additional studies regarding appropriate drug selection, dosage, and combination therapy for women.