Abstract Hypertension is rare in the young, but its prevalence increases with age. Exercise contributes to the prevention of hypertension in normotensive subjects and to the control of blood pressure in hypertensive patients. The overall cardiovascular risk of the hypertensive patient does depend not only on blood pressure but also on the presence of other risk factors, target organ damage, and associated clinical conditions. The recommendations for preparticipation screening, sports participation, and follow-up depend on the overall risk profile of the individual patient. When antihypertensive treatment is required in addition to nonpharmacologic measures, calcium-channel blockers and blockers of the renin-angiotensin system are currently the drugs of choice for the patient who exercises.