Indo-Asians are more prone to complications secondary to hypertension, including ischaemic heart disease and stroke. The prevalence of Type 2 diabetes in Indo-Asians is high and the British Diabetic Association recommends adequate blood pressure control below 140 mmHg systolic and 80 mmHg diastolic. Evidence for end-organ damage is an important aspect of management while treating hypertensive patients, as the risks escalate with the involvement of target organs. Investigations in patients with hypertension need to be organised with a view to excluding a secondary cause and determining other cardiovascular risk factors. The trial suggests that most patients would require two or more drugs to control blood pressure but that control is more difficult in older patients. Low-dose thiazide diuretics have been recommended as first-line therapy in older people and this has been reaffirmed by the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial results. Moderate to severe cognitive impairment can also affect the management of hypertension.