African Americans suffer from high rates of hypertension and hypertension-related complications. While racial/ethnic differences in blood pressure response to pharmacologic therapy have been described, most randomized hypertension trials with substantial enrollment of African Americans receiving standardized medical care do not support class-specific racial/ethnic differences in key clinical outcomes. Understanding health care systems and the socio-economic and demographic factors that impair access can enhance the ability of the provider to enlist and engage the patient for optimal blood pressure control and end organ protection.