For primary care physicians, managing hypertension is a challenging undertaking because it is a good example of the balance be-tween implementing evidence and working with patients' beliefs, ideas, and resources to help them improve their health. In this article the authors review the evidence supporting aggressive recommendations on prevention and treatment of hypertension to decrease cardiovascular, cerebrovascular, and renal disease. They review the public health implications of hypertension, but focus on the challenges clinicians face in working with patients to optimize their health with the financial and personal resources they have available.