INTRODUCTION: Epidemiological studies have unequivocally shown that hypertension (HT)is a major cardiovascular (CV) risk factor and that a direct linear relationship exists between the severity of the blood pressure (BP) elevation and the occurrence of CV events. AREAS OF AGREEMENT AND CONTROVERSY: The beneficial effects of the BP-lowering interventions have been recognized since a number of years. These include not only the reduction in CV morbidity and mortality but also the regression (or the delay of progression) of HT-related end-organ damage, such as left ventricular hypertrophy, vascular remodelling, endothelial dysfunction and renal damage. Along with these well-established features, antihypertensive drug treatment still faces a number of unmet goals and unanswered questions, such as the target BP values to achieve in high-risk patients, the threshold of treatment in low-risk patients as well as the choice of the therapeutic approach more likely to offer greater CV protection. CONCLUSION: Despite unmet goals, antihypertensive treatment has provided throughout the years successful results. Future efforts will be need to achieve a better BP control in the population and thus to obtain a greater CV protection.