Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e21 factors have hypertension. For example, 71% of US adults with diagnosed DM have hypertension.S2.4-4 In the Chronic Renal Insufficiency Cohort (CRIC), 86% of the participants Also, 28.1% of adults with hyperten- sion and CKD in the population-based REGARDS (Reasons for Geographic and Racial Differences in Stroke) study had apparent resistant hypertension.S2.4-6 In NHANES 1999 2010, 35.7% of obese individuals had hypertension.S2.4-7 The presence of multiple CVD risk factors in individuals with hypertension results in high absolute risks for CHD and stroke in this popula- tion. For example, among US adults with hypertension between had a risk of 10% to 20%, and only 18.4% had a risk <10%.S2.4-3 Modifiable risk factors for CVD that are common among adults with hypertension include cigarette smok- ing/tobacco smoke exposure, DM, dyslipidemia (includ- ing high levels of low-density lipoprotein cholesterol or hypercholesterolemia, high levels of triglycerides, and low levels of high-density lipoprotein cholesterol), overweight/ obesity, physical inactivity/low fitness level, and unhealthy The relationship between hypertension and other modifiable risk factors is complex and interdependent, with several sharing mechanisms of action and pathophysiol- ogy. CVD risk factors affect BP through over activation of the renin-angiotensin-aldosterone system, activation of the sympathetic nervous system, inhibition of the cardiac natri- uretic peptide system, endothelial dysfunction, and other Treating some of the other modifi- able risk factors may reduce BP through modification of shared pathology, and CVD risk may be reduced by treating global risk factor burden. Recommendation-Specific Supportive Text 1. 