Aging is associated with abnormalities in blood pressure homeostasis and may precipitate falls through transient underperfusion of the brain. Age-related declines in baro-reflex sensitivity, cerebral blood flow, and renal sodium conservation threaten normal blood pressure regulation and cerebral perfusion. Common clinical conditions associated with abnormal blood pressure homeostasis and falls in the elderly include postural hypotension, postprandial hypotension, carotid sinus hypersensitivity, and cardiac arrhythmias, all of which are exacerbated by hypertension. Further research is needed to understand the physiologic basis of abnormal blood pressure homeostasis, to explore the potential relationship between hypertension and falling, and to design new therapeutic approaches to this important cause of falls in the elderly.