The prevalence of hypertension in older people, aged ≥ 65 years, is high. Older patients have physiological and pathophysiological differences regarding cardiovascular function and cardiovascular disease compared to younger people. These include increased vascular stiffness, increased incidence of adverse effects, including falls resulting from frailty, and frequent hypotonia, including orthostatic and postprandial hypotonia. The presence of comorbidities may be associated with adverse effects in the course of antihypertensive treatment. In older patients, the use of thiazide or thiazide-like diuretics and dihydropyridine calcium channel antagonists in hypotensive therapy is particularly warranted.