Hypertension in Patients With Comorbidities Certain comorbidities may affect clinical decision-making in hypertension. These include ischemic heart disease, HF with reduced ejection fraction (HFrEF), HFpEF, CKD (includ- ing renal transplantation), cerebrovascular disease, AF, PAD, DM, and metabolic syndrome.S9-1 As noted in Section 8.1.2, this guideline generally recommends use of BP-lowering medications for secondary prevention of CVD in patients with clinical CVD (CHD, HF, and stroke) and an average BP 130/80 mm Hg and for primary prevention of CVD in adults with an estimated 10-year ASCVD risk of 10% and an average SBP 130 mm Hg or an average DBP 80 mm Hg. Although we recommend use of theACC/AHA Pooled Cohort Equations (http://tools.acc.org/ASCVD-Risk-Estimator/) to estimate 10-year risk of ASCVD to establish the BP threshold for treatment, the vast majority of adults with a co-morbidity are likely to have a 10-year risk of ASCVD that exceeds 10%. In some instances, clinical trial confirmation of treatment in patients with comorbidities is limited to a target BP of 140/90 mm Hg. In addition, the selection of medications for use in treating high BP in patients with CVD is guided by their use for other compelling indications (eg, beta blockers after MI, ACE inhibitors for HFrEF), as discussed in specific guidelines for the clinical condition.S9-2 S9-4 The present guideline does not address the recommendations for treatment of hyperten- sion occurring with acute coronary syndromes. Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e49 9.1. Stable Ischemic Heart Disease Recommendations for Treatment of Hypertension in Patients With Stable Ischemic Heart Disease (SIHD) References that support recommendations are summarized in Online Data Supplements 30-32. COR LOE Recommendations I SBP: B-R 1. In adults with SIHD and hypertension, a BP target of less than 130/80 mm Hg is DBP: C-EO I SBP: B-R 2. 