In contrast to historical practices, there are now strong evidence and guideline recommendations endorsing the use of antihypertensive medications in older adults with hypertension. Employing shared decision-making between the clinician and patient is crucial. This process should involve careful consideration of physiological changes with age, the risk of ADEs, and an individualized assessment of the benefits and harms when deciding to initiate or select specific antihypertensive medication therapy for older adults.