ASCVD was defined as a first CHD death, non-fatal MI or fatal or non-fatal stroke. Synopsis Whereas treatment of high BP with BP-lowering medi- cations on the basis of BP level alone is considered cost use of a combination of absolute CVD risk and BP level to guide such treatment is more efficient and cost effective at reducing risk of CVD than is use of BP level Practical approaches have been developed to translate evidence from RCTs into individual patient treat- ment recommendations that are based on absolute net ben- efit for CVD risk,S8.1.2-25 and several national and international guidelines recommend basing use of BP-lowering medica- tions on a combination of absolute risk of CVD and level of BP instead of relying solely on level of BP.S8.1.2-26 S8.1.2-31 Attempts to use absolute risk to guide implementation of pharmacological treatment to prevent CVD have had mixed results, with many reports of improvements in pro- vider prescribing behaviors, patient adherence, and reduc- tions in risk,S8.1.2-32 S8.1.2-38 but with others showing no impact on Use of global CVD risk assess- ment is infrequent in routine clinical practice,S8.1.2-41 S8.1.2-46 which suggests that intensive efforts would be required to achieve universal implementation. The choice of specific risk calculators for estimation of risk and risk threshold has been an important source of variability, ambiguity, and controversy.S8.1.2-47 S8.1.2-54 In addition, implementation of a standard (worldwide) abso- lute CVD risk threshold for initiating use of BP-lowering medications would result in large variations in medication use at a given level of BP across countries.S8.1.2-48,S8.1.2-54,S8.1.2-55 Future research in this area should focus on issues related to implementation of a risk-based approach to CVD prevention, including the use of BP-lowering medications. 