High blood pressure is the most common chronic medical problem prompting visits to primary health care providers, yet it is estimated that only 34% of the 50 million American adults with hypertension have their blood pressure controlled to a level of <140/90 mm Hg. Thus, about two thirds of Americans with hypertension are at increased risk for cardiovascular events. The medical, economic, and human costs of untreated and inadequately controlled high blood pressure are enormous. Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, and/or control of high blood pressure. Health care providers face many obstacles to achieving blood pressure control among their patients, including a limited ability to adequately lower blood pressure with monotherapy and a typical reluctance to increase therapy (either in dose or number of medications) to achieve blood pressure goals. Patients also face important challenges in adhering to multidrug regimens and accepting the need for therapeutic lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and, most importantly, lowering blood pressure significantly reduces cardiovascular morbidity and mortality, as proved in clinical trials. The medical and human costs of treating preventable conditions such as stroke, heart failure, and end-stage renal disease can be reduced by antihypertensive treatment. The recurrent and chronic morbidities associated with hypertension are costly to treat. Pharmacotherapy for hypertension therefore offers a substantial potential for cost savings. Pharmacoeconomic analyses regarding antihypertensive drug therapies, their costs, and the relevant reductions in health care expenditures are a useful framework for optimizing current strategies for hypertension management.