Trial results provide evidence of CVD prevention from use of BP-lowering medications in adults with an aver- age SBP 130 mm Hg or an average DBP 80 mm Hg and clinical CVD; 5-year risk of CVD (defined as stroke, CHD, HF, or other CVD death) of approximately 6% an estimated 10-year CVD death rate of approximately 4.5%;S8.1.2-4 or an annual rate of major CVD events of approximately 0.9% per year.S8.1.2-7 In the absence of clinical CVD, these risk estimates are roughly equivalent to a 10-year risk of ASCVD exceeding 10% as per the ACC/AHA Pooled Cohort Equations.S8.1.2-56 SPRINT (Systolic Blood Pressure Intervention Trial) provides additional support for the use of BP-lowering medications in patients without CVD at SBP levels 130 mm Hg; however, it is important to note that few SPRINT participants had untreated SBP between 130 mm Hg and 139 mm Hg at baseline. Furthermore, SPRINT used a Framingham 10-year risk of general CVD exceeding 15% to identify increased CVD risk.S8.1.2-8 Although this level of risk is lower than the levels described previously, being roughly equivalent to a 6% to 7% 10-year ASCVD risk per the ACC/AHA Pooled Cohort Equations, most of the participants in SPRINT had a much higher level of CVD risk. This recommendation differs from JNC 7 in its use of CVD risk, rather than diabetes or CKD, to recognize patients, including older adults, with a SBP/ DBP <140/90 mm Hg who are likely to benefit from BP lowering drug therapy in addition to nonpharma- cological antihypertensive treatment. 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. 