Data from the Hypertension Treatment Trials do not indicate that the metabolic effects of the medications used, namely diuretics in all and beta-blockers in some, are of great clinical significance. Effects on lipids are mainly short-term (about one year) and the increased incidence of significant hyperglycaemia and/or diabetes in treated compared with control or placebo subjects is < 1% in most trials. The use of these drugs has improved the prognosis of subjects with both severe and less severe hypertension. Despite these findings, it is possible that medications such as the calcium blockers, ACE inhibitors, or multiple-action drugs, e.g. the alpha-beta-blockers which have no negative and possibly have some positive effects on lipids and glucose metabolism, will improve outcome still further. We must await additional long-term trials to determine this. It is possible that combinations of small doses of two different agents from different classes of drugs will prove to be the ideal approach to hypertension management in the future: efficacy is improved and any adverse metabolic effects are minimised.