Purpose of Review <p>Cardiac conduction disease, a harbinger of pacemaker implantation, heart failure, and death, is commonly regarded as immutable. However, emerging research suggests it may be a target for upstream prevention strategies such as blood pressure management. This review summarizes recent evidence regarding blood pressure control and the development of conduction disease.</p> Recent Findings <p>Recent observational studies link hypertension to both prevalent and incident conduction disease. In randomized trials, intensive blood pressure control among hypertensive individuals reduced the incidence of left-ventricular conduction abnormalities in the form of fascicular- and left bundle branch blocks, while treatment with lisinopril independent of blood pressure control appeared to reduce conduction disease risk.</p> Summary <p>Understanding factors that influence conduction system disease development may help inform novel primary prevention strategies. Recent evidence suggests that treatment of hypertension may play a key role in the prevention of conduction disease.</p>