There is not increasing evidence that, from an epidemiological stand-point, treatment of diastolic hypertension in the elderly leads to a significant cardiovascular risk reduction; however, for the individual patient, the magnitude of absolute risk reduction is relatively small. More widespread use of ambulatory blood pressure recording is suggested in order to improve patient selection - i.e. to avoid antihypertensive treatment in patients with white coat hypertension - and to prevent overtreatment in patients with established hypertension. This strategy should result in a selection of elderly, hypertensive patients who are more likely to benefit from pharmacological treatment and thus restrict the number of patients needing treatment for prevention of a cardiovascular complication. Furthermore, by decreasing the risk of overtreatment, this strategy is likely to result in a decrease in the number of medication-related side effects such as coronary morbidity and mortality.