Thiazide-type diuretics and CCBs are recommended as first-line therapy for hypertension in elderly patients, based on the assumption they tend to have low renin essential hypertension and proven efficacy; yet the prevalence of chronic kidney disease and isolated systolic hypertension raises the possibility antihypertensive drugs that act through the renin-angiotensin system or by enhancing endothelial function may also be useful, as Dr David Bennett-Jones explain