Given that the lifetime risk of hypertension exceeds 80% in US adults,S8.1.3-3 it is likely that individuals with a normal BP will develop elevated BP in the future. BP may change over time because of changes in BP-related lifestyle fac- tors, such as degree of sedentary lifestyle, dietary sodium intake, body weight, and alcohol intake. Less commonly, secondary causes of hypertension can occur over time and lead to an increase in BP. Periodic BP screening can iden- tify individuals who develop elevated BP over time. More frequent BP screening may be particularly important for individuals with elevated ASCVD risk. 8.1.4. General Principles of Drug Therapy Recommendation for General Principle of Drug Therapy References that support recommendations are summarized in Online Data Supplement 25. COR LOE Recommendation III: Harm A 1. Simultaneous use of an ACE inhibitor, ARB, and/or renin inhibitor is potentially harmful and is not recommended to treat adults with Synopsis Pharmacological agents, in addition to lifestyle modification (see Section 6.2), provide the primary basis for treatment of high BP. A large number of clinical trials have demonstrated that antihypertensive pharmacotherapy not only lowers BP but reduces the risk of CVD, cerebrovascular events, and Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e43 Numerous classes of antihypertensive agents are available to treat high BP (Table 18). Agents that have been shown to reduce clinical events should be used preferentially. Therefore, the pri- mary agents used in the treatment of hypertension include thia- zide diuretics, ACE inhibitors, ARBs, and CCBsS8.1.4-8 S8.1.4-11 (see Section 8.1.6). Although many other drugs and drug classes are available, either confirmation that these agents decrease clinical outcomes to an extent similar to that of the primary agents is lack- ing, or safety and tolerability may relegate their role to use as sec- ondary agents. 