With the increase of middle-aged and elderly people in the super aging society, the number of hypertensive patients in Japan is anticipated to further increase from 43 million of 2014. Because the middle-aged and elderly patients tend to have polypathy compared to younger patients, more personalized treatment is necessary depending on comorbidity. The comorbidities that we should consider in hypertensive treatment include diabetes mellitus, dyslipidemia, and hyperuricemia resulted from a recent increase of obesity. Meanwhile, the hypertensive patients are often complicated with a stroke, heart disease, and chronic kidney disease. Thus, we need to plan and perform the latest optimal hypertensive treatment in each case. As the optimal hypertensive treatment, it is important to set the optimal target level of blood pressure control and to manage the comorbidity itself. While the target level of blood pressure control is basically “the lower, the better”, the setting of the target level in our country is not settled. To solve this issue, the investigator initiated clinical study by the Japanese society of hypertension “J-SPRINT preliminary study” has just started. In this symposium, we expect discussion regarding the optimal hypertensive treatment in patients with comorbidity based on the latest evidence and the experience in the clinical setting.