Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant cardiovascular (CV) risks and related kidney disease. Patients with prehypertension also have high prevalence of other CV risk factors, including dyslipidemia, diabetes, insulin resistance, obesity and the metabolic syndrome, as well as presenting with earlier evidence of target organ damage compared to normotensive persons. Hypertension and target organ damage, history of blood pressure management, and history of anti-hypertensive drugs from reserpine to aliskiren are discussed. Despite enormous advances in antihypertensive drug therapy, the number of people with uncontrolled hypertension has continued to rise. Preventive programs which increase awareness of the risks of uncontrolled hypertension and educate both physicians and patients on effective treatment interventions must be implemented in all regions of the world.