According to statistics, if 140/90mmHg is taken as the threshold, there are at least 1 billion hypertensive patients in the world, and the number is still growing steadily. A variety of antihypertensive drugs are available, but there is no unanimity among experts as to how far blood pressure should be lowered. In this regard, Dr. Aram V. Chobanian from Boston University Medical Center expressed his opinion, which was published in the recent NEJM. A decade ago, lowering blood pressure to below 140/90 mm Hg for people with hypertension seemed to be the default target. 2003 saw the introduction of JNC-7, which recommended lowering blood pressure to below 130/80 mm Hg, and even lower for patients with chronic kidney disease and diabetes. But then JNC-8 went on to recommend that lowering systolic blood pressure to less than 150mmHg is sufficient for people over 60 years of age. The AHA/ACC had a joint statement stating that blood pressure should be lowered to below 130/80 mmHg for patients with coronary artery disease (CAD) or with risk factors for CAD, and lowered even lower (below 120/80 mmHg) for patients with congenital heart disease. However, in 2015, it changed its opinion: for most patients with CAD, lower the blood pressure to below 140/90mmHg?and for older patients over 80 years old, lower the blood pressure to below 150/90mmHg. The results of the 2015 SPRINT clinical trial also imply that today’s blood pressure lowering targets are too high and should be reduced. A systolic BP target of 150 mmHg is really a bit too high for older patients, and a more aggressive BP-lowering regimen is acceptable if the older patient has concomitant cardiovascular disease or is at high risk. But shouldn’t most hypertensive patients be advised to lower their systolic blood pressure to below 120 mmHg? Dr. Aram is conservative about that view, especially since the high-intensity treatment group in the SPRINT study did not achieve the desired target blood pressure level. He believes that the results of the SPRINT study suggest that most hypertensive patients over the age of 50 without a history of diabetes or stroke will benefit from lowering their systolic blood pressure to below 130 mmHg. But then the burden on the clinician gets even heavier! Even with the early conservative 140/90 mmHg BP target, 1/3 to 1/2 of hypertensive patients in the United States alone have failed to meet the target, not to mention other countries, with some developing countries achieving less than 10%. If the systolic BP target is changed to 130 mmHg or even 120 mmHg, another large proportion of people will become “unstable BP”. In addition, in the high-intensity treatment group of the SPRINT study, the average combination of the three antihypertensive drugs had some patients who were never able to achieve the 120 mmHg BP target. Achieving such demanding BP targets will require more careful medication adjustment, greater use of combination agents, more monitoring of adverse effects, and increased outpatient follow-up, even though hypertensive disorders are now the most common diagnosis in hospital outpatient clinics across the United States. Dr. Aram has been on the front lines for more than half a century and has seen tremendous advances in the treatment of hypertension with many antihypertensive drugs. However, he expressed concern that the incidence of hypertension will continue to rise in the United States and around the world, as well as frustration with the inaction of current state departments in preventing hypertension. This is despite the fact that the Fomingham Heart Study from as early as 2009 revealed the truth – that most people will get hypertension if they live long enough – and it was also largely clear that increased exercise and dietary modifications can reduce weight and salt intake, thereby slowing age-related increases in blood pressure as well as improving other cardiovascular disease high risk factors. However, this practical approach is not being promoted. Changing ingrained habits is difficult but not completely impossible, and even addictions such as smoking can be successfully directed through smoking cessation programs. The same kind of success can be achieved in the prevention of hypertension, but it requires strong policy support and the generalization of the policy nationwide.