Across the age spectrum of hypertrophic cardiomyopathy (HCM), hypertension (HTN) is a common, comorbid condition in approximately half of all HCM patients. HCM and hypertensive cardiomyopathy lead to similar structural abnormalities in the myocardium, but these changes are generally more prominent in HCM. A composite of clinical variables may be used to differentiate these conditions. The appropriate treatment of HTN in HCM is not well defined, and recommendations for use of drugs with blood pressure-lowering effects have focused largely on the potential for exacerbating left ventricular outflow obstruction by reducing preload or afterload, rather than clinical endpoints used in outcome studies of HTN and HCM therapies.