Moxonidine is an imidazoline compound which acts on I-1 imidazoline 'receptors' in the central nervous system to reduce blood pressure, This novel mechanism of action is claimed to lead to fewer adverse effects than the older centrally-acting agents such as clonidine, In this review we examine the drug's pharmacology, clinical pharmacokinetics, efficacy as an antihypertensive agent including comparative studies with pre-existing drugs, and adverse effect profile, With a growing number of effective antihypertensive agents already available to the clinician, it is not yet clear whether moxonidine represents a significant advance in hypertension management.