Large scale studies have failed to show a substantial benefit of antihypertensive therapy on the incidence of ischaemic heart disease. 2. This may be due to adverse effects of antihypertensive drugs on plasma lipoproteins or because of failure to adequately manage other risk factors for atherogenesis. 3. Hypercholesterolaemia is very common in patients receiving antihypertensive therapy, and is difficult to manage successfully using existing treatment strategies. 4. The achievement of a reduction in mortality and morbidity from ischaemic heart disease amongst hypertensive patients represents a major challenge. Success will probably depend upon the development of adequate methods of lowering plasma cholesterol levels.