Hypertension is clearly associated with cardiovascular disease (CVD) and death. With age, the incidence of hypertension increases, making it imperative that we understand the pathophysiology and treatment of hypertension, especially in the elderly. Data regarding individuals older than 80 years are emerging, with more attention being given to patterns and treatment of hypertension in the elderly. Thus far, we have done a poor job with treating hypertension; this is due to multiple factors, including a reluctance of physicians to treat hypertension in the elderly because of concern of causing harm. In this article, the author's discuss the history and pathophysiology of hypertension, hypertension population studies, and hypertension treatment studies with a focus on the elderly. The author's findings both justify and encourage antihypertensive treatment in all hypertensive adults.