Hypertension is the most common reason for visits to physicians' offices and the primary reason for prescription drugs. Complications of untreated and poorly treated hypertension are devastating including cardiovascular disease, heart failure and stroke. This makes treatment decisions critical in terms of both cost and quality of life. Thiazide diuretics are consistently considered the first line treatment. The effectiveness in lowering BP and in decreasing morbidity and mortality are well established. However, the incidence and severity of adverse reactions are very concerning. Alternative pharmacotherapy has the potential benefits of decreased cost and fewer adverse reactions. CoQ10 has been the most widely studied alternative pharmacotherapy for hypertension. This review of the literature compares the effectiveness of thiazide diuretics to CoQ10 for the treatment of hypertension. There is preliminary evidence of effectiveness and large multi-center randomized controlled trials are indicated. Knowledge of the emerging trends and scientific support of alternative pharmacotherapies is important for the Doctor of Nursing Practice.