Stroke is the third most-frequent cause of death after cancer and heart disease in developed countries, and is one of the most common reasons for developing cognitive impairment and vascular dementia. Hypertension is known to be the most important factor for developing stroke and vascular dementia. In addition, the presence of cerebral white matter lesions (WML) is an important prognostic factor for the development of stroke, cognitive impairment and dementia. Older age and hypertension are constantly reported to be the main risk factors for cerebral WML. Hypertensive patients have a higher rate and extent of areas of cerebral WML compared with normotensives and, among hypertensive patients, treated uncontrolled patients have higher rates of WML than those who are controlled. Recent evidence strongly supports the idea that the presence of cerebral WML in hypertensive patients should be considered a silent early marker of brain damage.