Adapted with permission from Whelton Copyright 2017, American College of Cardiology Foundation and the American Heart Association, Inc. CLINICAL STATEMENTS AND GUIDELINES treatment outweighs the potential harm at thresh- old BP 130/80 mm Hg. 3. Meta-analyses and systematic reviews of trials that compare more intensive BP reduction to standard BP reduction report that more intense BP lowering sig- nificantly reduces the risk of stroke, coronary events, major cardiovascular events, and cardiovascular Achieving an addi- tional 10 mm Hg reduction in SBP reduced CVD risk when compared with an average BP of 158/82 to 143/76 mm Hg, 144/85 to 137/81 mm Hg, and 134/79 to 125/76 mm Hg. Patients with diabetes mellitus and CKD were included in the analyses.S4.4-39 4. Most patients with CKD have a 10-year ASCVD risk 10%, requiring initiation of antihypertensive drug therapy at BP 130/80 mm Hg. In SPRINT, the participants with CKD who were randomized to intensive therapy (SBP target <120 mm Hg) derived the same beneficial reduction in CVD events and all-cause mortality that was seen among in their counterparts without CKD, with no difference seen in the principal renal outcome.S4.4-34 Other that evaluated the effect of differ- ing BP goals on CKD progression in patients with CKD demonstrated no benefit for more intensive BP reduction, although post hoc follow-up analy- ses favored lower targets in patients with more These trials were under- powered to detect differences in CVD event rates. Several meta-analyses and systematic reviews support more intensive BP treatment to reduce cardiovascular events but do not demonstrate a reduction in the rate of progression of kidney More intensive BP treat- ment may result in a modest reduction in glomeru- lar filtration rate, which is thought to be primarily attributable to a hemodynamic effect and may be reversible. 