In order to determine the impact and trend of hypertension related deaths in the overall mortality of urban Sierra Leoneans, a review of death certificate records in the capital Freetown over the period 1983-1992 was undertaken. A total of 25119 consecutive records were examined to identify those with hypertension as a major or contributory cause of death. For the purpose of this study, hypertensive stroke, cardiac and renal deaths were selected as the main hypertension related disorders. Hypertension related deaths accounted for an average of 7.5% of all deaths and 13.7% of deaths in those aged 40 years and above between 1983 and 1992. For the latter group, stroke deaths accounted for 5.2%, cardiac deaths for 4.7%, and renal deaths for 0.8% of total mortality. There were more male hypertensive stroke deaths but when expressed as a percentage of the total deaths, no sex difference was noted. Hypertensive stroke deaths accounted for 7% of all deaths in the age group 50-69 years in females, while hypertensive cardiac deaths, caused 6% of deaths in the 60-69 year age group in both sexes. Hypertensive renal death was infrequently recorded being present mainly in the 40-49 year age group predominantly in males. When all hypertension related deaths were considered together, their major impact was in the seventh decade in females and in the eighth decade in males accounting for approximately 20% and 16% of all deaths respectively. Hypertension related deaths appeared to show a steady increase over the 10 year study period. Hypertension is a significant cause of death particularly in elderly urban Sierra Leoneans in Freetown and deaths from hypertension may be increasing.