Heavy alcohol use causes or exacerbates a number of medical conditions. In particular, hypertension (HTN), the most common primary diagnosis in primary care, is particularly alcohol-sensitive. In patients with HTN, excessive alcohol use (3 or more drinks a day) can interfere with successful blood pressure control and facilitate disease complications. Excessive alcohol use is one of 6 major causes of treatment-resistant HTN. This article summarizes the literature on the relationship between excessive drinking and HTN as well as findings supporting a beneficial BP-lowering impact of routine alcohol screening and intervention with hypertensive adults. Screening specifically for alcohol-induced hypertension rather than an alcohol use disorder per se is emphasized. Recent health services investigations have also addressed the problemof practical implementation of HTN alcohol screening in busy medical settings. These findings have important implications for the successful management of HTN patients in general and treatment-resistant HTN patients in particular.