Hypertension is one of the most important causes of cardiovascular morbidity and mortality and its treatment is a major focus of primary and secondary disease prevention strategies. The treatment of hypertension continues to evolve and the need for guidance on the use of newer screening tools, techniques for blood pressure measurement and different classes of drug therapies led to the first European guidelines for the management of arterial hypertension being issued in 2003 by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). The first update of these guidelines in 2007 crystallized much of the modern thinking about the evaluation and treatment of patients with hypertension with a sharp focus on detailed assessment of subclinical organ damage and cardiovascular disease risk, as well as differential blood pressure treatment targets and thresholds for those at different levels of risk. This review focuses on the 2007 ESH/ESC Guidelines, highlighting the evolution of treatment strategies in order to meet the challenge of improving blood pressure control in Europe. In particular, development of patient-centred treatment strategies, the benefits of blood pressure lowering, drug-specific influences over clinical outcomes, recommendations for the pharmacological treatment of hypertension and the role of combination therapies are discussed.