Summary: Arterial hypertension (AH) is one of the most common chronic diseases in Poland. It affects approximately 10 million Poles, including 76% of citizens over 65 years of age. The ESC/ESH criteria for blood pressure (BP) cut-off, and target BP values differ between people aged 65-80 years and 80+ years. For the very old patients the target BP values should be < 150/80 mmHg, but not below 130/70 mmHg. Analyses of data from numerous studies indicated that too low a blood pressure values would not reduce cardiovascular risk but can increase the number of adverse reactions and increase the risk of mortality. Properly treated hypertension in older patients rests upon finding a balance between pharmacotherapy to target values and the risk of potential side effects of such treatment. Adjusting the type of therapy to the patient's biological age, treatment according to the principle “start low, go slow”, reduction of polypharmacy, e.g. by using drugs with a beneficial effect on several diseases at the same time, will help to reduce the risk of adverse drug reactions. An important element in the optimal treatment of hypertension is the active search for coexisting syndromes such as frailty syndrome, orthostatic hypotension, chronic pain, or falls. Both withholding treatment for arterial hypertension and too aggressive lowering of blood pressure, may cause serious consequences for the patient's health.