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Seventy percent of people over 65 years of age have hypertension, and one third of elders fall each year. These conditions frequently coexist, and each carries a risk for substantial functional decline or mortality. This article reviews the risks of and interventions to reduce falls in the elderly patient with hypertension.A systematic review of the published and unpublished literature and consensus panel recommendations through January 2008 are discussed.Hypertension management in the frail elder at risk for fall must include a thoughtful assessment of the relative risks and benefits of treatments that are most likely to preserve function, independence, and quality of life. Stringent adherence to guidelines may not be appropriate for all patients. The periodic use of a standardized fall risk screening tool can assist the nurse practitioner (NP) to identify patients at risk for falls and adjust medication management accordingly.This article will assist the NP to weigh management options in the context of the complex elderly patient.