Hypertension is a highly prevalent, major risk factor for stroke in both men and women in the developed world. Recent data from population-based studies emphasize the substantial risks conferred by elevated levels of systolic blood pressure (SBP) over and above diastolic blood pressure (DBP) and the risks of borderline elevations in SBP. Decades of randomized treatment trials have demonstrated the clear net benefit on stroke and cardiovascular disease (CVD) conferred by antihypertensive therapy. Recent data emphasize the stroke prevention benefits of treatment of isolated systolic hypertension and the benefits of nonpharmacological dietary and other lifestyle interventions for lowering elevated blood pressure. Many classes of antihypertensive agents are available, and the largest trial comparing the risks and benefits of commonly used agents, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial, provided evidence for a net benefit from diuretic therapy as the initial agent. Here, we review the epidemiology of hypertension, the relations of hypertension with risk for stroke, and the evidence for benefit from pharmacological and nonpharmacological treatments.