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. The only prospective clinical trial of BP reduction in individuals with normal BPs is the Trial of Preventing Hypertension (TROPHY) study,19 in which subjects with an SBP of 130 to 139 mmHg or a DBP of 85 to 89 mmHg were randomized to be treated for 2 years with either the angio- tensin receptor blocker (ARB) candesartan or placebo and followed up for an additional 2 years. Hypertension devel- oped in significantly (P<0.007) more participants in the pla- cebo group (two thirds of this cohort at 4 years) than in the candesartan group, with a relative risk reduction of 66.3% at 2 years and 15.6% at 4 years. In addition, the treatment of prehypertension with candesartan appeared to be well toler- ated, and serious adverse events occurred in 3.5% and 5.9% in patients treated with candesartan and placebo, respectively. However, the study was not designed or powered to assess CVD outcomes. In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, with a mean follow-up of 4.7 years, a tar- get BP of <120 compared with <140 mmHg was not associ- ated with a reduced risk of a composite of CVD events (heart attack, a stroke, or a cardiovascular death).20 However, the incidence of stroke was significantly less in the intensively treated group. Table 1. Applying Classification of Recommendations and Levels of Evidence. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. 