Hypertension affects two-thirds of persons 60 years or older. Treatment of hypertension has clear cardiovascular benefits in younger adults, but, as is true for most classes of medications, it is less clear whether these benefits extend to the growing elderly population. Medications used to treat hypertension are often prescribed for the remaining years of a patient’s life, increasing the risk of adverse effects and financial strain. Clinicians must balance the uncertain cardiovascular benefits with these potential adverse effects when deciding whether to prescribe an antihypertensive medication to frail older adults.