Millions of people have hypertension, and a lesser percentage have both diabetes and hypertension. Hypertension and diabetes together are the most common etiologies for development of renal failure and death from cardiovascular causes in the Western world. The number of people who achieve a goal blood pressure shown to markedly reduce cardiovascular risk is 27.4%. Moreover, only 11% of the population in the NHANES III database achieved the recommended goal of less than 130/85 mm Hg for those with diabetes. Consequently, the rate of people starting dialysis continues to climb and while cardiovascular-associated mortality has been reduced, morbidity has not changed appreciably. The presence of target organ injury, left ventricular hypertrophy, and microalbuminuria signifies a long duration of pressure overload. All of these manifestations of pressure overload are associated with higher cardiovascular event rates and renal disease progression when compared to people without these manifestations. This difference in event rates may be related to shorter duration and/or intensity of blood pressure elevation or achievement of blood pressure goals in people with established hypertension. It is clear that patients with evidence of target organ injury need aggressive blood pressure lowering to the goals set forth by the JNC VI in order to both regress injury to the cardiovascular and renal systems and help maximally reduce cardiovascular and renal injury. (c)2000 by Le Jacq Communications, Inc.