Race and ethnicity provide an important construct that identifies individuals at increased risk for hypertension and related cardiovascular complications. While a significan proportion of health care disparity can be attributed to social, cultural and ecomnomic factors, mapping of the human genome allows for a biological construct of race. A systematic review of the effect of race on the response to antihypertensive therapy was performed in 2007. In this current review, an update of this subject is provided. There is clear evidence that consideration of race will inform the approach to hypertensive therapy. This position will be supported with clinical trial data that examine both blood pressure response and cardiovascular and renal outcomes. The putative effects of genetic predisposition will also be examined.