The basic underlying pathophysiological processes underlying the major complications of hypertension (that is, heart attacks and strokes) are thrombogenesis and atherogenesis. Indeed, despite the blood vessels being exposed to high pressures in hypertension, the complications of hypertension are paradoxically thrombotic in nature rather than haemorrhagic. The evidence suggests that hypertension appears to confer a prothrombotic or hypercoagulable state, which can be related to conventional risk factors, target organ damage, complications and long-term prognosis, as well as different antihypertensive treatments. Further work is needed to examine the mechanisms leading to this phenomenon, the potential prognostic and treatment implications, and the possible value of measuring these parameters in routine clinical practice.