The Systolic Blood Pressure Intervention Trial (SPRINT) found that randomization of non-diabetic participants at high cardiovascular risk to an intensive (systolic blood pressure (SBP) <120mmHg) versus standard (SBP<140mmHg) target resulted in 25% risk reduction in first cardiovascular composite event (i.e., cardiovascular death or non-fatal myocardial infarction, stroke, or hospitalization for heart failure) and a 27% risk reduction in all-cause mortality. In this post hoc analysis, we sought to determine factors associated with failure to achieve the SBP target in 4,678 SPRINT participants randomized to the intensive treatment group. Using a generalized estimating equation model, we assessed variables associated with failure to achieve the intensive SBP target as a repeated outcome collected during serial follow-up visits, including the occurrence of serious adverse events. In the multivariable model adjusted for baseline demographic, clinical, and laboratory variables, older age, higher systolic blood pressure, underlying chronic kidney disease, higher number of antihypertensives, and moderate cognitive impairment were associated with failure to achieve the intensive SBP target. Occurrence of a serious adverse event during the trial was associated with 20% higher odds of failure to achieve the SBP target. Participants of Hispanic ethnicity had 47% lower odds of failure to achieve the intensive SBP target relative to non-Hispanic whites. Understanding barriers to achieving intensive SBP targets should allow clinicians to optimize management of hypertension in patients at high risk for cardiovascular disease.