The 2014 guideline panel failed to identify evidence of differential benefits or harms of treatment using an SBP goal of 140 mm Hg with an age threshold of 60 years. There is little RCT evidence of risk or benefit in treating persons younger than 60 years to this target, except in those with diastolic hypertension. The guideline indicates that no qualifying evidence was found comparing an SBP less than 140 mm Hg to any other SBP goal for persons younger than 60 years (2). However, in persons aged 60 years or older, the SHEP (Systolic Hypertension in the Elderly Program) trial showed benefit of treating hypertension to an SBP goal between 140 and 145 mm Hg (Table 2) (15). HYVET (Hypertension in the Very Elderly Trial) found a benefit of an SBP target of less than 150 mm Hg on health outcomes, including mortality in persons aged 80 years or older (16). Patients in the HYVET treatment group achieved an SBP of 144 mm Hg at 2 years compared with 159 mm Hg in the control group, and blood pressures continued to decrease in both groups until the end of the trial. Therefore, HYVET and the SHEP trial provide evidence that reducing SBP to around 140 mm Hg has substantial benefit without major harm in older persons. Thus, the best evidence available for an SBP target around 140 mm Hg, which meets the guideline RCT criteria, is in persons older than 60 years. The lack of benefit seen in 2 Japanese trials in older individuals (JATOS [Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients]  and the VALISH [Valsartan in Elderly Isolated Systolic Hypertension] trial ) was cited by some to rationalize the higher SBP target, but these trials were underpowered (Table 2). The SHEP trial and HYVET together reported 365 strokes and more than 285 coronary heart disease events, whereas JATOS and the VALISH trial only had a combined total of 125 strokes and 67 coronary heart disease events. In addition, the much larger FEVER (Felodipine Event Reduction) trial (19) did not meet criteria for inclusion in the panel's deliberation (Table 2). This trial, which was conducted in a Chinese population (age range, 50 to 79 years; mean age, 62 years), reported a significant 27% reduction in its primary outcome, as well as significant reductions in all CVD, total mortality, coronary heart disease, and heart failure in patients treated to an SBP of 137 mm Hg with a thiazide diuretic–calcium-channel blocker combination versus 143 mm Hg with a thiazide diuretic plus placebo (19).