Hypertension is a major public health concern whose prevalence increases with age and is a major risk factor for disability, cognitive decline, cardiovascular events, and death; yet hypertension is frequently undertreated, and sometimes overtreated, in older adults. Evidence from recent clinical trials indicate treating hypertension to targeted blood pressures of < 130/80 is safe and beneficial in ambulatory older adults free of cognitive impairment. However, because clinical trials have tended to exclude persons with cognitive impairment or poor functional status and nursing home residents, management of hypertension in these groups of older adults remains uncertain and the current guidelines recommend using an individualized approach incorporating clinical judgment and patient values. As with management of other chronic conditions, age alone should not be the only consideration to hypertension treatment goals in this heterogeneous population.