Heart Failure Recommendation for Prevention of HF in Adults With Hypertension References that support the recommendation are summarized in Online Data Supplement 33. COR LOE Recommendation I SBP: B-R 1. In adults at increased risk of HF, the optimal BP in those with hypertension should be less DBP: C-EO Synopsis Antecedent hypertension is present in 75% of patients with In the Cardiovascular Health StudyS9.2-5 and the Health, Aging and Body Composition Study,S9.2-6 of 4408 persons (53.1% women, with a mean age of 72.8 years, living in the community, and not receiving antihyper- tensive drugs at baseline) developed HF over 10 years.S9.2-7 Compared with those with an average SBP <120 mm Hg, the adjusted incidence of HF was increased 1.6, 2.2, and 2.6 times in those with average SBPs between 120 and 139 mm Hg, between 140 and 159 mm Hg, and 160 mm Hg, No RCTs are available that compare one BP-lowering agent to another for the management of patients with HF. The following recommendations for treatment of hyperten- sion in HF are based on use of drugs that lower BP and also have compelling indications for management of HF (with HFrEF or HFpEF) as recommended in current ACC/AHA Recommendation-Specific Supportive Text 1. In adults with hypertension (SBP 130 mm Hg or DBP 80 mm Hg) and a high risk of CVD, a strong body of evidence supports treatment with antihypertensive medications (see Section 8.1.2) and more-intensive rath- er than less-intensive intervention (see Section 8.1.5). In SPRINT, a more intensive intervention that targeted an SBP <120 mm Hg significantly reduced the primary outcome (CVD composite) by about 25%.S9.2-9 The in- cidence of HF, a component of the primary outcome, was also substantially decreased (hazard ratio: 0.62; 95% confidence interval: 0.45 0.84). 