All hypertensive target organ damage essentially develops as a direct and/or indirect consequence of the vascular pathology that results from an exposure to increased intravascular pressures. Such indirect consequences include ischemia and dysfunction of the distal microvasculature without it being directly exposed to elevated pressures. In any event, there are significant differences in the pathogenesis of such injury between target organs which result in different degrees of macro and microvascular disease and are also reflected in the specific clinical phenotypes. Such differences also probably account for the differences in the quantitative relationships between BP increases and the increase in the relative and/or absolute risk for a given target organ damage. Therefore, from the pathogenesis perspective, the spectrum of hypertensive target organ pathology can be broadly separated into (a) macrovascular pathology; (b) cardiac pathology; and (c) microvascular pathology. At the outset, it also needs to be acknowledged that the following discussion addresses the consequences of hypertension in the context of generic elevation of vascular pressure without trying to separate the pathogenic contribution of individual components of the pressure wave (systolic, diastolic, mean, pulse). One of the important paradigm shifts in hypertension has been the recognition of the importance of systolic rather than mean or diastolic BP as a predictor of adverse outcomes, particularly in older individuals. Similarly, the important issues of BP lability and the relative merits of the various BP measurement approaches (clinic, home, ambulatory) are also not addressed but some relevant references are cited.