A process exists whereby patients with hypertension are identified and exposed to the SDM tool. A formal SDM encounter occurs between the patient and provider using an evidence-based decision tool before initiation or adjustment of GDMT. Communication skills training for providers A program exists to provide skills in SDM to practitioners, with periodic assessments of providers skills. Built-in triggers in EHRs to remind clinicians to provide a decision aid to patients with hypertension. The use of an SDM tool is documented within the EHR. A process exists for identifying patients with hypertension who have not participated in SDM so that such a process can be offered. Rationale Decisions about primary prevention should be collaborative between a clinician and a patient. SDM occurs when practitioners engage patients in discussions about personalized ASCVD risk estimates and their implications on the perceived benefits of preventive strategies, including lifestyle habits, goals, and medical therapies. Collaborative decisions are more likely to address potential barriers to treatment options.166 169 SDM is defined as an approach where clinician and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences. 79,170 It draws on the principles of patient-centered care to increase patient commitment to treatment plans, including long-term adherence to drug therapy and lifestyle modification.168,171,172 Adherence to GDMT of hypertension can be enhanced by SDM between clinicians and patients. Patients should be engaged in the selection of antihypertensive drug therapy and lifestyle modification strategies, with consideration of individual values, preferences, and associated conditions and comorbidities (2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease14 ). 