Hypertension is a major risk factor for cardiovascular disease, and is both common and amenable to treatment. Several major new studies have appeared recently and in response the National Institute for Health and Clinical Excellence and the British Hypertension Society have collaborated to update their respective guidelines on primary hypertension, and to agree joint recommendations. The update focuses only on pharmacological aspects of treatment. Wherever possible, the recommendations are based on the clinical outcomes of mortality, stroke, myocardial infarction, heart failure, and new onset diabetes mellitus, rather than on blood pressure lowering. A brief treatment algorithm is included. In summary, either calcium channel inhibitors or thiazide-type diuretics should be the preferred initial agent for use in primary hypertension in most patients, although angiotensin converting enzyme (ACE) inhibitors (including angiotensin-II receptor inhibitors if ACE-intolerant) are preferred in patients younger than 55.