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Objective: Optimal antihypertensive therapy in very old subjects requires their understanding and acceptance. We investigated elderly patients' willingness to accept antihypertensive therapy and their desire for information and for participation in medical decisions., Methods: After standardized explanations about hypertension and its treatment, 120 patients (mean age 83.8 ± 7.4 years) were asked whether they would accept hypertension treatment in 15 hypothetical scenarios with different outcomes (myocardial infarction/heart failure, stroke, and death), absolute risks/risk reductions, and risk of side effects., Results: Fifty percent to 60% of patients accepted treatment in all scenarios; only 4% to 7% clearly refused it, and 30% to 40% were unsure. Paradoxically, the Autonomy Preference Index (API) indicated a variable, overall low desire for participation in medical decisions (mean score 58.9 ± 13.9 mean ± SD, on 100), including about hypertension, but patients wanted to receive extensive medical information (mean score 69.6 ± 17.2)., Conclusions: Our data indicate that many patients prefer to delegate the final decision to their physician, although most want to receive extensive information. Although the decision to treat belongs to the physician, initial acceptance of antihypertensive therapy does not imply that patients really understand and adhere to it. True understanding and acceptance of treatment requires attention to patients' preferences and repeated explanations during follow-up., (Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)