The rationale for drug treatment in patients with an SBP 140 mm Hg or a DBP 90 mm Hg and an estimated 10-year risk of CVD <10% is based on several lines of evidence. First, the relationship of SBP with risk of CVD is known to be continuous across levels of SBP and similar across groups that differ in level of absolute risk.S8.1.2-10 Second, the relative risk reduction attributable to BP-lowering medication therapy is consistent across the range of ab- solute risk observed in trials,S8.1.2-3,S8.1.2-11,S8.1.2-58 supporting the contention that the relative risk reduction may be simi- lar at lower levels of absolute risk. This is the case even in a meta-analysis of trials in adults without clinical CVD and an average SBP/DBP of 146/84 mm Hg.S8.1.2-5 Finally, modeling studies support the effectiveness and cost- effectiveness of treatment of younger, lower-risk patients Figure 4. Blood pressure (BP) thresholds and recommendations for treatment and follow-up. Colors correspond to Class of Recommendation in Table 1. *Using the ACC/AHA Pooled Cohort Equations.S8.1.2-56,S8.1.2-57 Note that patients with DM or CKD are automatically placed in the high-risk category. For initiation of RAS inhibitor or diuretic therapy, assess blood tests for electrolytes and renal function 2 to 4 weeks after initiating therapy. Consider initiation of pharmacological therapy for stage 2 hypertension with 2 antihypertensive agents of different classes. Patients with stage 2 hypertension and BP 160/100 mm Hg should be promptly treated, carefully monitored, and subject to upward medication dose adjustment as necessary to control BP. 