In the past two to three decades, the practice among hypertension specialists has been to lower blood pressure with the strong assumption that morbidity and mortality would be reduced. This was largely based on large clinical trials done in the 1960s and 1970s that did not include angiotensin-converting enzyme inhibitors or calcium-channel blockers. Performing large clinical trials is expensive and the results often do not apply to individual patients. Until recently, noninvasive methods to monitor end-organ effects of elevated blood pressure and other cardiovascular risk factors were limited. The development of high-resolution ultrasound and evolving magnetic resonance technology will allow early detection of heart and blood vessel changes and will make monitoring of the progression and regression of disease possible. This will allow better selection of treatment programs for each patient.