This might influence BP targets or the preferred agents use to control BP, especially if heart failure, angina, cerebral vascular insufficiency, or peripheral vascular diseases are prominent. The presence of heart failure or cardiomyopathy may lead clinicians to initiate or diuretics independently of BP treatment. Similarly, angina may be an indication for beta-blockers or calcium-channel blockers. Hypotension (orthostatic or persistent) due to BP-lowering treatment may exacerbate the risk of falls and fractures in the elderly, especially in patients with co-morbidities such as cerebrovas- cular disease, osteoporosis, or vitamin D deficiency. Drugs and the elderly. The pharmacology and pharmaco- dynamics of BP drugs also change with age, mainly because of reduced GFR, but also due to changes in hepatic function, volume of distribution, and other issues that are less well Side-effect profiles may also vary, either owing to altered end-organ sensitivity to the drugs, co- morbidities, or interactions with other medications, such as diuretics, NSAIDs and COX-2 inhibitors which may accentuate the adverse kidney effects of renin angiotensin blockade.384 Goals of BP management in the elderly. It is particularly important to individualize care in the elderly, bearing co- morbidities in mind. A philosophy of patient-centered care (rather than disease-directed care) is particularly relevant as the elderly become very elderly.385 The high likelihood of elderly patients developing cardiac and cerebrovascular complications in the context of a high BP, along with evidence that kidney function may decline more slowly in the elderly than in younger patients (particularly when the GFR should lead to a greater emphasis on vascular rather than kidney outcomes. 