Treat- ment adherence and medication costs were thought to be beyond the scope of this review, but the panel acknowledges the impor- tance of both issues. Theevidencereviewdidnotincludeobservationalstudies,sys- tematic reviews, or meta-analyses, and the panel did not conduct itsownmeta-analysisbasedonprespecifiedinclusioncriteria.Thus, information from these types of studies was not incorporated into the evidence statements or recommendations. Although this may be considered a limitation, the panel decided to focus only on RCTs because they represent the best scientific evidence and because therewereasubstantialnumberofstudiesthatincludedlargenum- bers of patients and met our inclusion criteria. Randomized con- trolled trials that included participants with normal BP were ex- cluded from our formal analysis. In cases in which high-quality evidencewasnotavailableortheevidencewasweakorabsent,the panelreliedonfair-qualityevidence,panelmembers knowledgeof thepublishedliteraturebeyondtheRCTsreviewed,andpersonalex- perience to make recommendations. The duration of the guideline developmentprocessfollowingcompletionofthesystematicsearch may have caused the panel to miss studies published after our lit- erature review. However, a bridge search was performed through August 2013, and the panel found no additional studies that would have changed the recommendations. Many of the reviewed studies were conducted when the over- all risk of cardiovascular morbidity and mortality was substantially higher than it is today; therefore, effect sizes may have been over- estimated. Further, RCTs that enrolled prehypertensive or nonhy- pertensiveindividualswereexcluded.Thus,ourrecommendations do not apply to those without hypertension. In many studies fo- cused on DBP, participants also had elevated SBP so it was not pos- sibletodeterminewhetherthebenefitobservedinthosetrialsarose from lowering DBP, SBP, or both. In addition, the ability to compare studiesfromdifferenttimeperiodswaslimitedbydifferencesinclini- cal trial design and analytic techniques. 