For the purposes of secondary prevention, clinical CVD is defined as CHD, congestive HF, and stroke. Several meta- analyses of RCTs support the value of using BP-lowering medications, in addition to nonpharmacological treat- ment, in patients with established CVD in the absence of hypertension, defined previously by an SBP 140 mm Hg or a DBP 90 mm Hg.S8.1.2-1,S8.1.2-6,S8.1.2-7,S8.1.2-9 Many RCTs of BP lowering in adults without CVD have used inclusion criteria designed to increase the level of CVD risk in the study populations to increase trial ef- ficiency by facilitating shorter duration and a smaller sample size. As a consequence, few relatively low-risk adults with hypertension have been included in the trials. 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. 