Hypertension is the most powerful, independent, preventable risk factor for death and disability from cardiovascular diseases. Initial clinical assessment and diagnostic testing are essential to disclose; (a) secondary causes to avoid resistant cases that needs specific therapy, (b) co-morbid conditions that limits choice of drug-therapy, and (c) target organ damage that dictates specialized approach. In this review article; an algorithm for its management is outlined that includes also specific practical approach to those with emergencies, urgencies and co-morbid conditions. Keywords: adults, coronary artery disease, heart failure, hypertension, renal failure, stroke.