Frailty and hypertension are common syndromes and chronic conditions among older adults, sharing a close and bidirectional relationship. A potential reverse causality may exist between frailty and antihypertensive therapy in the elderly, and whether frail older patients should undergo intensive hypertension management remains debated. It is particularly important to note that current clinical practice necessitates a comprehensive frailty assessment before formulating hypertension management strategies for this population. Antihypertensive regimens should be formulated based on the presence of functional dependence and the extent of impairment in autonomous mobility due to frailty. The comprehensive management of hypertension in these patients requires shared decision-making among patients, healthcare professionals, and caregivers. This involves individualized interventions for frailty or hypertension through measures such as lifestyle modifications and pharmacological treatments, with dynamic adjustments to the management plan based on the patient’s blood pressure control status and adverse reactions. This approach aims to enhance patient adherence and achieve desired management outcomes. This article analyzes and elaborates on the particularities of hypertension treatment in frail older adults, specific strategies, intervention methods, and follow-up management.