Obesity and hypertension frequently coexist. Measuring blood pressure (BP) accurately in obese patients is challenging and may require strategies that are less accurate, such as forearm cuffing or use of wrist cuffs. Pathophysiologic mechanisms of hypertension may differ between obese and non-obese individuals, which may result in differing effects of common BP-lowering medications. However, to date, there is insufficient trial data to recommend a different approach to medication selection based on body mass index. Additionally, the goal BP is generally not different between obese and non-obese patients. Weight loss should be emphasized for obese patients with hypertension, and interventions in addition to diet and exercise may include weight loss medications and bariatric surgery. Recognition and treatment of obstructive sleep apnea is also important.