While symptoms are common during the detection and treatment of hypertensive patients it is rarely the case that either uncomplicated essential hypertension (of whatever severity) or treatment presents insurmountable problems. Unfortunately they frequently result in changes in effective therapy or encourage clinicians and prescribers to settle with altered and inadequate treatment goals. This review considers the association of patients symptoms in the management of hypertension. It considers the relationship of symptoms at the time of diagnosis and the impact of symptoms voiced during active drug treatment. The data relating antihypertensive therapy to adverse symptoms during chronic therapy and the consequences of this on treatment goals are summarised.