For older adults ( 65 years of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/ benefit is reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. Synopsis Because of its extremely high prevalence in older adults, hyper- tension is not only a leading cause of preventable morbidity and mortality but, perhaps more importantly, is under-recognized as a major contributor to premature disability and institution Both SBP and DBP increase linearly up to the fifth or sixth decade of life, after which DBP gradually decreases while SBP continues to rise.S10.3.1-6 Thus, isolated systolic hypertension is the predominant form of hyperten- sion in older persons.S10.3.1-7,S10.3.1-8 RCTs have clearly dem- onstrated that BP lowering in isolated systolic hypertension (defined as SBP 160 mm Hg with variable DBP 90, 95, or 110 mm Hg) is effective in reducing the risk of fatal and nonfatal stroke (primary outcome), cardiovascular events, and Cross-sectional and longitudinal epidemiologic studies in older adults have raised questions about the benefits of more intensive antihypertensive treatment and the relation- ship between BP lowering and risk of falls.S10.3.1-13 Treatment of elevated BP in older persons is challenging because of a high degree of heterogeneity in comorbidity, as well as poly-pharmacy, frailty, cognitive impairment, and variable life expectancy. 