Any elevation in BP is accompanied by increased risk of cardiovascular and cerebrovascular events and renal damage. The most distinctive pathological consequence of untreated hypertension is atherosclerosis. Eventually, in untreated hypertensives, 50 per cent die of coronary heart disease and heart failure, 33 per cent of cerebrovascular events, and 15 per cent of renal failure. It is important to remember that there is no cut off point in hypertension where complications cease to occur. The relationship between BP and risk of hypertensive events is continuous, consistent and independent of other risk factors. In other words, the natural history of untreated hypertension is always bad. A thorough general and systemic clinical examination is necessary in all cases since important clues to the causation and to the end organ involvement can be obtained.