Giraffes are the highest living animals on Earth and therefore are challenged by gravity more than any other species. In particular the cardiovascular system needs to adapt to this challenge. Giraffes have a mean blood pressure around 200 mmHg, which ensures a mean arterial pressure near the head of 100 mmHg when the giraffe is standing with the neck in a near vertical position. This immediately raises several questions. How do giraffes avoid edema in the legs where the arterial pressure is 300 mmHg or higher? How does the heart produce a pressure of 200 mmHg, and what is the energy required for this endeavor? How can the kidney tolerate a pressure of about 200 mmHg and does this mean that giraffes have a high glomerular filtration rate? What is the arterial pressure in the head of giraffes when they drink, and how is perfusion of the brain maintained when they lift their head after drinking? In this short review, we present some answers to these questions.