There is growing acceptance of the centrally acting antihypertensive agents as single-agent therapy in the treatment of mild to moderate essential hypertension. An important characteristic of newer agents such as guanabenz is the absence of sodium retention during treatment, which minimizes the problem of tolerance seen with many of the established antihypertensive drugs. The centrally acting agents appear to work equally well in younger and older patients, and are also effective in both blacks and whites. They can be administered effectively and safely in hypertensive patients who have renal insufficiency. Moreover, it has been shown that guanabenz is effective in treating hypertensive diabetic patients; it does not change plasma glucose concentrations or the treatment requirements of diabetic patients. In general, the centrally acting agents appear to have no deleterious metabolic effects and may actually decrease the plasma concentrations of cholesterol. Their wide applicability and the absence of specific contraindications to their use make them attractive alternatives as first-line therapy for the treatment of hypertension.