Hypertensive leg ulcers are painful, superficial, rapidly spreading necrotic wounds on the dorsolateral leg. They occur in older patients with long-standing hypertension without peripheral arterial occlusive disease. Medical therapies include antihypertensive agents, wound debridement, and wound dressings. Only surgical therapies with grafting achieve rapid pain relief and healing. In this randomized, double-blind controlled study, Senet et al demonstrate that topical becaplermin gel is not superior to hydrogel dressing for hypertensive leg ulcer closure, suggesting that surgical management remains the most promising treatment.