Hypertension is the major modifiable risk factor for fatal, nonfatal strokes and other vascular diseases. In a pooled analysis of 61 prospective studies including about one million individuals, the reported risk of stroke increased progressively with blood pressure from values as low as 115/75 mm/Hg. Each increment of 20/10 mm/Hg doubles the risk of cardiovascular disease and such a correlation is consistent at all ages. Blood pressure lowering strongly reduces the risk of either first stroke or recurrent stroke but the possibility that specific drugs may prevail over others for protection from stroke remains unclear. There is some evidence that specific classes of antihypertensive drugs have different effects and/or their pharmacological actions differ in patient subgroups. Currently, there are five classes of first-line blood pressure lowering drugs: diuretics, beta-blockers, calcium channel blockers, angiotensin-converting inhibitors and angiotensin II receptor blockers. This review evaluates the development of antihypertensive therapies and the latest studies of arterial hypertension and stroke prevention.