As a mat- ter of convenience, however, it can be assumed that the vast majority of older adults have a 10-year ASCVD risk 10%, placing them in the high risk category that requires initiation of antihypertensive drug therapy at BP 130/80 mm Hg (see Section 8.1.2, Figure 4 and Table 23 for BP thresholds for initiating antihypertensive drug treatment). Large RCTs using medications to re- duce hypertension-related CVD risk with a mean fol- low-up of 2 years have now included a large number of adults 65 years of age. These trials have enrolled a broad range of ages 65 years, including persons in their 90s and even 100s, as well as those with mild-to-mod- erate frailty but who were ambulatory and able to travel to a treatment clinic. In these patients, RCTs have shown that BP lowering decreased CVD morbidity and mortali- ty but did not increase the risk of orthostatic hypotension Analysis of the NHANES (2011 2014) data set indicates that 88% of US adults (98% men and 80% women) 65 years old have a 10- year predicted ASCVD risk 10% or have a history of CVD (CHD, stroke, or HF). For persons 75 years of age, 100% have an ASCVD risk score 10% or a history of CVD. Therefore, the BP target of 130/80 mm Hg would be appropriate (see Section 8.1.2). Initiation of antihypertensive therapy with 2 agents should be un- dertaken cautiously in older persons, and they need to be monitored carefully for orthostatic hypotension and history of falls. In SPRINT, the benefit was for an SBP goal of <120 mm Hg. Older persons may pres- ent with neurogenic orthostatic hypotension associated with supine hypertension. This is particularly common in Parkinson s disease and other neurodegenerative dis- orders. 