This observational study assessed the achievement of treatment goals, as defined by the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). These goals are: <140/80 mm Hg in elderly patients (65 years and older), <130/80 mm Hg in patients with diabetes or kidney disease, and <130/85 mm Hg in younger patients (younger than 65). From July 2006 to May 2007, 72 physician members of the Fukushima Hypertension Conference enrolled a total of 3320 patients from Fukushima Prefecture, Japan. The median age of the patients was 71 years and 46% were male. The success rate was 27% among patients with diabetes mellitus or renal disease, 30% among those younger than 65 years, and 66% among the elderly without the diseases. Factors significantly associated with an increased risk of failure to achieve goals were obesity, dyslipidemia, family histories of diabetes mellitus or hypertension, and number of antihypertensive drugs used. The presence of atherosclerotic complications decreased the risk. This study revealed low achievement rates, identified the importance of weight control and family histories, and indicated a need for better management to prevent complications. J Clin Hypertens (Greenwich). 2009;11:333–341.©2009 Wiley Periodicals, Inc.