Since 2013, hypertension guidelines have been updated in several countries and regions around the world, mainly including the 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) hypertension guidelines, the 2014 International Society of Hypertension/American Society of Hypertension (ISH/ASH) clinical practice guidelines for the management of hypertension in the community, the 2014 U.S. Prevention, Detection, Evaluation, and Treatment of Hypertension Committee 8th Report (JNC8), the 2014 Japanese Hypertension Guidelines, and the 2014 Canadian Hypertension Guidelines. All of these guidelines emphasize development based on evidence-based principles and are very similar in their recommendations for important issues in the management of hypertension, but there are still some minor differences, and these differences are particularly prominent in the management of older patients with hypertension. The European and American guidelines set the BP target for elderly hypertensive patients at 150 mmHg systolic based on the HYVET et al. study, while the Japanese hypertension guidelines recommend 140 mmHg as the target value for systolic BP control based on the subgroup results of the FEVER study in China. Although there is only a 10 mmHg difference between the two BP target values, two aspects need to be considered. First, whether there are studies showing that lowering systolic blood pressure below 140 mmHg is harmful, i.e., whether there is a J-shaped curve problem. Currently, the J-curve is mostly a post hoc analysis, and prospective studies are still needed to give the final answer; second, is it not possible to lower blood pressure lower without evidence from prospective studies? The development of a strategy requires not only evidence from randomized controlled studies but also evidence from many other sources combined with expert wisdom. In a country where the stroke burden remains high, lowering blood pressure, if tolerated by patients, is reasonable to reduce the overall cardiovascular events and burden. Application of β-blockers There is still much controversy in recent years regarding the use of β-blockers in patients with hypertension. With the exception of the 2013 ESH/ESC hypertension guidelines, several other recent guidelines either no longer recommend β-blockers as the initial drug of choice for patients with uncomplicated hypertension, such as the JNC8; or put forward restrictions, such as the 2014 ISH/ASH Clinical Practice Guidelines for the Management of Hypertension in the Community and the 2014 Japanese Hypertension Guidelines. The reasons for these results are mainly due to the poor stroke reduction effect of β-blockers compared with other antihypertensive drugs. In the past controversies, the recommenders emphasized that β-blockers are widely indicated and irreplaceable; the opponents emphasized that β-blockers are not advantageous for hypertensive patients without comorbidities, especially elderly patients. In the author’s opinion, based on the various evidence available, more attention should be paid to whether patients have other indications when choosing β-blockers for the treatment of hypertension. Antihypertensive strategies in elderly patients Since the publication of the HYVET study, the question of whether antihypertensive therapy is needed in elderly patients over 80 years of age seems to have been resolved. However, the patients enrolled in that study were patients in good health, and almost all guidelines recommend a blood pressure control goal of 150/90 mmHg or less for such patients, and none have made any more aggressive recommendations. A recent Dutch study presented at the European Hypertension Annual Meeting showed that low diastolic blood pressure was associated with increased morbidity and mortality in older patients with multiple comorbidities; and in patients of lower biological age, increased diastolic blood pressure was associated with increased morbidity and mortality. The investigators point out that we need to rethink the definition of ideal blood pressure, and in particular, the biological age of the population should be fully taken into account. In the author’s opinion, although this is only an observational study, it allows us to quantitatively assess the health status of patients in order to take appropriate therapeutic measures and avoid under- and over-treatment.