The availability of pharmacologic agents has contributed to a reduction in the morbidity and mortality of hypertensive cardiovascular disease. However, antihypertensive agents are associated with changes that may adversely affect patients receiving therapy. Nutritional and metabolic consequences of antihypertensive therapy may be associated with enhanced atherosclerosis. The abnormalities in lipid metabolism, carbohydrate tolerance, and changes in the renin-angiotensin-aldosterone axis are reviewed. The mechanisms by which antihypertensive therapy causes these complications are unknown and their exact role in hypertensive cardiovascular disease remains to be elucidated. Appropriate selection of therapeutic agents and dietary manipulations may minimize the metabolic and nutritional consequences of antihypertensive therapy.