Increased blood pressure, especially systolic blood pressure (SBP), is linearly associated with an increased risk of cardiovascular disease and stroke. The attributable risk of vascular disease due to elevated blood pressure is greater for normal and high normal blood pressures and stage 1 hypertension than for more advanced hypertension (stages 2 and 3). The development of noninvasive methods for measuring the effects of blood pressure on the vascular system help identify early vascular disease, high risk populations at similar levels of blood pressure, and successful methods of therapy. The future goals of the control of elevated blood pressure should be to prevent: (1) the rise in blood pressure associated with increasing age; (2) the development of subclinical vascular disease associated with even slightly elevated blood pressure; and (3) clinical disease. Measurement of subclinical vascular disease should be a component of both observational epidemiological studies and clinical trials. The subclinical measures should include those primarily associated with the progression of atherosclerosis and the pathophysiology of elevated blood pressure.