It is becoming increasingly clear that hypertension and metabolic risk factors in women are inter-related and often share underlying causes. Menopause acts explicitly as a risk factor by reducing the direct beneficial effect of ovarian hormones upon cardiovascular functions and indirectly by negatively influencing other risk factors for coronary artery disease--i.e. hyperinsulinaemia, blood cholesterol, blood pressure, coagulation etc. Adverse changes in one factor may induce adverse changes in a variety of other risk factors and it is important to consider co-ordinated changes when evaluating these patients rather than attempt to isolate independent factors. Similarly with treatment, the prevalence of metabolic syndrome in postmenopausal hypertensive women has important implications and some antihypertensive drugs may worsen the already altered metabolic profile of these patients while others may be beneficial. Centrally-acting sympatholytic agents, e.g. moxonidine, are therefore important to consider in hypertensive postmenopausal women who experience other symptoms of metabolic syndrome.