This is the second resubmission of a CSR&D CDA-2 proposal to provide five years of research and salary support to Adam Gepner, MD. The CDA will prepare him to become an independent VA geriatric cardiovascular disease investigator with clinical research expertise in geriatric cardiology, exercise physiology, arterial pathophysiology. This application combines clearly defined training activities, continuous collaboration with a multidisciplinary mentorship committee, and a novel research plan. Dr. Gepner proposes to non-invasively measure acute changes in arterial stiffness parameters to identify older Veterans with greater “arterial reserve” - the ability of the arteries to rapidly respond to changes in blood flow and pressure with stress and then rapidly return to baseline. The central hypothesis is that arterial reserve, determined by change in arterial stiffness measures following acute exercise or administration of sublingual nitroglycerin, will be greater in non- hypertensives and those with controlled blood pressure than in those with poorly controlled blood pressure. His proposal aligns with VA priorities because undertreatment of hypertension is well-recognized in the VA system. Dr. Gepner hopes to provide new tools to personalize hypertensive care by identifying individuals that can tolerate more aggressive blood pressure treatment goals thereby reducing adverse cardiovascular disease (CVD) events. Resting arterial stiffness predicts future CVD events, is tightly linked with blood pressure, and progresses most rapidly in older individuals with poorly controlled hypertension. Arterial stiffness is dynamic and responds acutely to both exercise and administration of antihypertensive medications. The arterial response to exercise and blood pressure medications is variable in older individuals, likely due to differences in arterial reserve. The primary scientific objective of this CDA is to investigate acute changes in arterial stiffness parameters with exercise and nitroglycerin administration in participants with varying degrees of blood pressure control and those without hypertension. Three specific aims will be pursued in a prospective study of 180 ambulatory, community dwelling, Veterans ≥60 years old who will be recruited from the Care Coordination Home Telehealth Network (CCHT) and Madison VA primary care clinics: Aims 1 and 2 are to determine if changes in arterial stiffness parameters following 1) exercise and 2) acute blood pressure reduction with short-acting sublingual nitroglycerin are associated with differences in baseline blood pressure control in older hypertensive Veterans and compared to a non-hypertensive age- and sex-matched non-hypertensive control group. Aim 3 is to determine associations between exercise capacity and changes arterial stiffness parameters among older hypertensive Veterans to ensure that the effects of lower blood pressure do not negatively impact functional capacity. Dr. Gepner will complete didactic tra...