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Purpose of Review: This article will summarize the effects of more intensive blood pressure (BP) control on cardiovascular, cognitive, and renal outcomes among elderly (age ≥75 years) individuals at high risk for cardiovascular events. Subsets of patients who may not benefit and obstacles to implementation will be addressed. The authors' insights will conclude the review., Recent Findings: A burst of new research regarding the effects of lower BP targets on cardiovascular, cognitive, and renal endpoints among the elderly has been published. Achieved values of 123 mmHg systolic in those without diabetes or prior stroke revealed striking declines in all-cause mortality, heart failure, and stroke. Although there was no benefit on the incidence of dementia, mild cognitive impairment was reduced. A trend towards modest declines in renal function and higher adverse event rates with normalization of BP were noted. Whether those with poor functional status or diastolic hypotension realize comparable gains remains unknown., Summary: Intensive BP control (systolic goal 120-130 mmHg systolic) results in lower rates of all-cause mortality and major adverse cardiac events. Elderly individuals with a good functional status and no history of diabetes or stroke are suitable candidates.

Hypertension is the second most common cause of chronic kidney disease (CKD) and is a potentiator of kidney failure when accompanying disease. CKD is a common cause of resistant hypertension. Nephropathy progression has dramatically slowed over the past 3 decades from an average of 8 to between 2-3 mL/min per year regardless of diabetes status. The incidence of very high albuminuria as well as progression from high albuminuria very high albuminuria has substantially decreased over the past 3 decades. This improvement relates to better blood pressure control using agents that slow nephropathy as well as better glycemic and cholesterol control., (Copyright © 2016 Elsevier Inc. All rights reserved.)