Randomized trials have shown that BP lowering in patients with hypertension produces rapid reductions in cardiovascu- that are highly consistent with data from observa- tional studies. For example, a 10-mmHg lower usual SBP (or a 5-mmHg lower usual DBP) is associated with a 50% to 60% lower risk of stroke death and an 40% to 50% lower risk of death resulting from CAD or other vascular causes at middle age, benefits that are only slightly smaller in older However, in one study, high blood pressure in the very elderly (>85 years) was not a risk factor for mortal- ity, irrespective of a history of hypertension. Whereas blood pressure values below 140/70 mm Hg were associated with Likewise, there are inconsistencies across end points in the older population, with a significant associa- tion of lower BP with lower stroke deaths and HF but not with a lower rate of myocardial infarction (MI) in patients Several studies (Heart Outcomes Prevention Evaluation Survival and Ventricular Enlargement [SAVE],17 and European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease [EUROPA])18 have shown a beneficial effect of angiotensin-converting enzyme (ACE) inhibitors on CVD outcomes in individuals, some hypertensive and some not, but all with established CVD or at high risk for its development. However, we do not yet have outcome studies of treatment of prehypertension Rosendorff et al Treatment of Hypertension in Patients With CAD 1375 in individuals with BPs in the range of 130 to 139/80 to 89 mmHg. 