Recently, a number of national and international hypertension guidelines were updated. This review aims to compare the latest guidelines including NICE (2011), JNC8 (2013), ESH/ESC (2013), and Korean guideline (2013, KSH). In general, KSH is very similar to ESH/ESC on BP class, goal BP, and drug recommendations. All the guidelines have the same target of 140/90 mmHg for the general adult population and strict control in for the elderly is not consistently better than mild control, but, the definition of elderly varies between the guidelines and the recommendations for specific groups of patients (diabetes, or CKD). ESH/ESC and KSH recommend five specific medication classes including ACE-I or ARBs, CCB, DD, and BB to be used as initial therapy. NICE, on the other hand, recommends three specific medication except for BB and DD, and JNC8 recommends four drug classes except for BB. However, the physician’s treatment decisions regarding the management of patients should consider an individual’s clinical characteristics and circumstances using guidelines only as a framework.