It has been calculated that hypertension ranks as the fourth largest mortality risk factor in the world, predicting 6% of all deaths. Mild hypertension accounts for the largest proportion of cardiovascular deaths in the United States because of its high prevalence. Thus, mild hypertension should be the focus of treatment efforts. In addition, to achieve better results in the next century, we will have to refocus the treatment from the global goal of blood pressure lowering to exploration of specific effects of drugs on the diverse pathophysiologic aspects of hypertension including the complex metabolic and hemodynamic aberrations associated with human hypertension, as well as trophic factors. Another disconcerting feature of current hypertension management is the inadequate lowering of the blood pressure in those patients treated for hypertension. The National Health and Nutrition Examination Study (NHANES) survey in United States shows that patients treated for hypertension have blood pressure values that are only slightly lower than in untreated hypertensives and remain higher than in normotensive subjects. Patient compliance with treatment is one major problem. The development of better tolerated drugs ought to bring improvement. Overall, an educational effort aimed at physicians, the general public, and health care providers is necessary to improve the treatment of hypertension and reverse the negative trends in cardiovascular mortality.