An observational cohort study involving 4071 hyper- tensive individuals aged 80 years or older (mainly men, since they were recruited from the Veterans Affairs Administra- tion) supports this notion.43 All subjects were classified as hypertensive according to the International Classification of Diseases (ICD-9) code, 9.9% as having chronic renal failure, and 84.5% were taking anti-hypertensive medica- tions. A J-shaped relationship between BP and survival was seen. Patients with BP o130 139 mm Hg systolic or o70 79 mm Hg diastolic were more likely to die during 5 years of follow-up than those with BP 130 139 mm Hg systolic or 70 79 mm Hg diastolic. With each further 10 mm Hg decrease in systolic or diastolic BP to o100 mm Hg systolic or o50 diastolic the risk increased, suggesting that overly aggressive BP control might be harmful in this age group. A series of retrospective analyses of INVEST has further highlighted the issue of J-shaped relationships between systolic BP, diastolic BP and outcomes in elderly hypertensive patients with CAD.40,42,231 The risk of all cause mortality and myocardial infarction, but not stroke, increased with reductions in diastolic BP in the patient group as a whole, all of whom had CAD and were being treated for high BP.40 In elderly patients included in the study, nadirs of risk occurred at particular systolic and diastolic BP levels, with the nadirs generally increasing with age. In patients aged 70 to 80 years, risk increased once systolic BP was less than 135 mm Hg or diastolic BP o75 mm Hg, while the risk increasing when systolic BP was o140 mm Hg or diastolic BP These relationships may be due to confounding and should not be used to set BP targets in this population. 