The need for specific recommendations for managing high blood pressure in African Americans is highlighted by compelling evidence of poorer cardiovascular and renal outcomes in this group compared with white Americans. With this consensus statement, the Hypertension in African Americans Working Group provides primary care providers with a practical, evidence-based clinical tool for achieving blood pressure goals in African American patients. Barriers to normalizing blood pressure in African Americans are too often attributed to biological and social factors, with an inadequate focus on the role of medical management. Simply stated, a key obstacle is the failure of medical providers to treat high blood pressure early and persistently to an appropriate blood pressure target. A new approach is needed to reduce the adverse outcomes associated with high blood pressure in African Americans. Traditional strategies (eg, accepting blood pressure levels above target goals, titrating to high-dose monotherapy, and avoiding specific classes of antihypertensive medications) have proved unsuccessful. The "best practice" strategies described in this article are intended to achieve efficacy in blood pressure reduction in tandem with protection against target-organ damage. These strategies involve assessing cardiovascular risk; setting, achieving, and maintaining an appropriate blood pressure target; assisting patients to implement therapeutic lifestyle changes; and initiating effective pharmacologic interventions early and persistently.