The metabolic syndrome is a highly prevalent condition currently considered to be a cluster of metabolic and cardiovascular risk factors, including blood pressure elevation. A higher risk for progression from high normal blood pressure to hypertension has been observed in individuals with metabolic syndrome and, when hypertension is established, hypertension seems to confer a higher cardiovascular risk on top of the risk induced by blood pressure elevation itself. Therefore, assessment of metabolic syndrome components can result in a clinical utility strategy to manage hypertension based on individual risk. In subjects with metabolic syndrome, intense lifestyle measures should be adopted and antihypertensive drug treatment instituted whenever blood pressure is ≥140/90 mmHg because subjects with metabolic syndrome have higher prevalence of multiple target organ damage and increased levels of inflammatory markers, which are associated with higher cardiovascular risk. The antihypertensive treatment should preferably consist of blockers of the renin-angiotensin system with the addition, when needed, of a calcium antagonist and/or a low dose thiazide diuretic. As the other cardiovascular risk factors like, for example, the other elements of the metabolic syndrome broaden the blood pressure ranges associated with increased cardiovascular risk, the blood pressure goal in subjects with metabolic syndrome is suggested to be 130/85 mmHg even in the absence of diabetes.