Regular physical activity and training are associated with reductions in blood pressure (BP), yet elevated BP is one of the most common abnormalities found during the pre-participation physical evaluation of athletes. Hypertension (HTN) remains the most common cardiovascular condition encountered in athletic populations, therefore all athletes require screening for HTN. Because athletes often have white coat HTN, BP recordings outside the office are also necessary. The 36th Bethesda Conference classified sports according to their varying physiologic demands and provided specific recommendations for the evaluation, treatment, and sport participation of athletes with HTN. In general, angiotensin-converting enzyme inhibitors and other vasodilators are the medications of choice for active and athletic patients because of their limited interference with cardiovascular conditioning. Other agents can be used but some sports governing bodies proscribe the use of certain antihypertensive medications such as beta-blockers for elite athletes.