Affecting more than 60 million Americans, hypertension is one of the most common medical conditions. It is the most common cardiovascular disorder in the United States, and it remains a significant cause of cardiovascular morbidity and mortality by predisposing to catastrophic events such as myocardial infarction and stroke. High blood pressure can be recognized and managed by psychiatrists in a variety of settings. Hypertension should be diagnosed when the average of two or more diastolic blood pressure measurements on at least two subsequent occasions is 90 mm Hg or higher, or when the average of multiple systolic blood pressure readings on two or more occasions is 140 mm Hg or greater. Evaluation should be directed toward finding treatable secondary etiologies, elucidating other cardiovascular risk factors that can be modified, and investigating target organ damage. Treatment can involve nonpharmacologic as well as pharmacologic interventions. Antihypertensive medications are known to be associated with psychiatric side effects such as depression, confusion, and psychosis. Problems with compliance, psychiatric symptoms, medication interactions, and side effects present unique challenges for the general medical care of psychiatric patients. This update will help psychiatrists to treat hypertension confidently while paying particular attention to the special considerations of the populations they are most likely to see.