Hypertension in elderly patients is common and is associated with unique challenges. This study examines the prevalence of comorbidities in elderly hypertensive patients and evaluates the association between comorbidities and other covariates with blood pressure goal attainment. Data were collected through retrospective review of medical records and included patient characteristics, comorbidities, treatment-related variables, and blood pressure goal attainment. At least 1 comorbidity was present in 88% of patients, and 61% had multiple comorbidities. The most common comorbidity was isolated systolic hypertension. The presence of diabetes or isolated systolic hypertension at initial visit and treatment with a thiazide diuretic at the final clinic visit were associated with significantly higher odds of patients not achieving blood pressure goal. A diagnosis of heart failure was associated with lower odds of not achieving blood pressure goal. These issues should be given special consideration during the evaluation, treatment selection, and long-term monitoring of this population.