The effect of antihypertensive drugs on the incidence and mortality of coronary heart disease has been disappointing. One possible reason for this lack of effect may be the interaction between the drugs and the lipid metabolism. Norwegian studies indicate that other reasons may be that treatment was started on doubtful criteria, or that insufficient consideration was given to the whole constellation of risk factors in hypertensive subjects. In addition, studies from the National Health Screening Service suggest that antihypertensive drugs have an adverse effect on risk of incidence and death from coronary disease among patients receiving these drugs, even when other risk factors are adjusted for. Therefore the lipid theory may not explain the lack of effect of antihypertensive treatment. The importance of exercising caution in using all kinds of antihypertensive drugs is emphasized.