In JNC 7, the BP Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e41 threshold for initiation of antihypertensive drug therapy was 140/90 mm Hg for the general adult population and 130/80 mm Hg for adults with diabetes or CKD. Since the publication of JNC 7 in 2003, we have gained additional experience with risk assessment and new data from randomized trials, observational studies and simu- lation analyses have demonstrated that antihypertensive drug treatment based on overall ASCVD risk assessment combined with BP levels may prevent more CVD events than treatment based on BP levels alone.S8.1.2-15 S8.1.2-24 According to an analysis of NHANES 2011-2014, the new definition results in only a small increase in the per- centage of US adults for whom antihypertensive medica- tion is recommended in conjunction with lifestyle modifi- cation. The previously cited meta-analyses are consistent with the conclusion that lowering of BP results in benefit in higher-risk individuals, regardless of their baseline treated or untreated BP 130/80 mm Hg and irrespective of the specific cause of their elevated risk. These analy- ses indicate that the benefit of treatment outweighs the potential harm at threshold BP 130/80 mm Hg. 2. This recommendation is consistent with prior guidelines, such as JNC 7. In addition, for those for whom nonphar- macological therapy has been ineffective, antihyperten- sive drug treatment should be added in patients with an SBP 140 mm Hg or a DBP 90 mm Hg, even in adults who are at lower risk than those included in RCTs. 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. 