An appreciation of the cardiac effects of antihypertensive drugs and important pharmacologic advances in the past 10 years have permitted a more rational approach to the management of the patient with both coronary artery disease and hypertensive left ventricular hypertrophy. Since this is a particularly high-risk group of patients, early detection and optimal management of ischemic symptoms and hypertension are necessary. Beta-blocking agents are ideal agents (in the absence of heart failure) since their efficacy has been proved in both coronary artery disease and hypertension. Similarly, calcium slow-channel blocking agents have both antianginal and antihypertensive properties. When arterial pressure reduction is needed quickly, caution is required in the choice of an agent since adverse reflexive cardiac effects may occur, particularly with pure arteriolar dilators. If a diuretic is required, serum potassium levels should be carefully monitored since both coronary artery disease and left ventricular hypertrophy already increase the risk of life-threatening dysrhythmias. The decrease in mortality from coronary heart disease seen in the past 10 years is likely to be further improved by specific attention to management of such high-risk groups as those with associated hypertensive left ventricular hypertrophy.