Clinical trials indicate that many antihypertensive medications alter blood lipids. These lipid changes may be of sufficient magnitude to influence subsequent coronary heart disease rates. We examined this association in a large population sample (N = 15,918, ages 25–74, 12% on antihypertensive medication) surveyed cross-sectionally from 1980 to 1986. Subjects taking antihypertensive medication had a mean serum total cholesterol 4.0 mg per dl higher than those not taking these medications after we adjusted for age, sex, weight, smoking, alcohol, blood pressure, and exercise. High-density lipoprotein cholesterol was lower in the medicated group by 2.5 mg per dl. There was no evidence that the length of medication use was related to lipid levels.