Arterial hypertension is often part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides), glucose intolerance, insulin resistance and hyperuricemia. Using Adult Treatment Panel III criteria, prevalence is higher than in the general population and the metabolic syndrome (MS) can be found in as many as one third of patients. In hypertensives with MS, a high prevalence of hypertension-induced target organ damage and a negative prognostic value have been described. Dietary advice and life style changes should be strongly recommended and prompt pharmacologic treatment is required to control high blood pressure and to reduce risk. The effect of particular antihypertensive drugs on other components of the MS is an important clinical issue with consequences for the success of the treatment.