Hypertension is the most common chronic disease in the West Indies, and is a major health problem today being among the 10 most common causes of death in the English-speaking territories of the region. Most patients have essential hypertension. Renal failure, stroke, and cardiac failure are the most common complications, myocardial infarction being relatively uncommon in black patients. While an earlier report from the Caribbean suggested that beta-blockers were not effective for treating black hypertensives, recent experience with these drugs show that they are useful particularly when administered along with a diuretic. Beta-blockers may be required in higher doses than those commonly recommended for patients in Europe and North America, but even small doses of thiazide diuretics are effective in lowering the blood pressure of West Indian hypertensives. West Indians show a combination of personalistic, naturalistic, and modern medical beliefs, which need to be understood in order to mount effective programmes for the management of hypertension in the community.