Summary: Hypertension is the most prevalent disorder in patients above 65 years of age. The choice of antihypertensive therapy of older patients is influenced not only by the level of blood pressure but also by the comorbid conditions. Frailty syndrome affects 34.5% of women and 29.0% men aged 80–84 years in Poland and is an important factor influencing antihypertensive therapy. In patients aged above 80 years, the antihypertensive monotherapy is initiated when blood pressure is at or above the value of 160/90 mmHg. In stage 3 hypertension, the therapy should be initiated with two medications preferably combined in single tablet. The blood pressure target in this group of patients is less than 140/80 mmHg, with the optimum systolic blood pressure being between 130–139 mmHg. Based on the results of HYVET study, the first-choice therapeutic options in the oldest patients include indapamide and perindopril. In the case of combination therapy, the medications should be started with lowest efficacious doses, and the blood pressure reduction should be guided by patient’s tolerance. Some of the studies on hypertension in the octogenarian population indicate that too low blood pressure reduction may increase the risk of fatal events. Therefore, the balance should be retained between the attainment of blood pressure target and the risk of therapy-related complications. The screening for frailty syndrome may be useful in designing the optimum therapy, tailored to the individual needs of the patient.