This chapter focuses on the particularities of the athletic population, the acute and chronic responses of physical exercise on blood pressure (BP) levels, evaluation, and treatment. It discusses thespecific and practical issues regarding the interaction between some common prescribed medications, diet, and exercise on body fluid balance and performance. Although the prevalence of hypertension is reported to be lower in athletes, compared to that of the general population, it must be underlined that systemic hypertension is also the most common cause for exclusion, at least temporary, for competitive sport participation. A prospective study, in middle-aged endurance competitive athletes, reported a 38% prevalence of masked hypertension. From the results of this study, it could be recommended to use ambulatory BP measurement in endurance athletes presenting with no optimal office BP. In the general population, higher fitness level is associated with a lower prevalence of hypertension and low fitness is inversely associated with the risk of developing hypertension at baseline.