SPRINT provides further evidence that intensive SBP lowering reduces CV events and death in those at high CV risk. Those bene ts targeting SBP <120 mm Hg compared to <140 mm Hg in SPRINT extended to CKD, the elderly, and those with frailty.91,107 In a prespeci ed analysis, the bene ts of targeting SBP <120 mm Hg in SPRINT included a signi cant reduction in the combined endpoint of probable dementia and mild cognitive impairment, with no interaction with baseline CKD.108 Secondary analyses further suggest that the bene cial effect of intensive BP lowering on the incidence of mild cognitive impairment per se may extend to those with and those who are aged 80 years or older.96 A recent meta-analysis of 74 RCTs with broader inclusion criteria than those discussed above102,105,106 concluded that the effect of BP lowering differed by baseline BP with no clear effect on death or CV disease in participants with no prior coronary heart disease and SBP <140 mm Hg at baseline.109 This nding has been used by some guideline groups, such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom, to justify a more conservative approach to BP-lowering therapy than that advocated in the present guideline. However, the inclusion of large numbers of trials comparing antihypertensive drugs versus placebo, not lower versus higher BP target, and importantly, those in which BP measurement technique was less precisely speci ed makes drawing conclusions challenging.109 Adults with CKD. A meta-analysis from the Blood Pressure Lowering Treatment Trialists Collaboration, which included trials of antihypertensive drugs versus placebo and trials of different BP targets, found that the proportional reduction in CV events with more intensive BP treatment was independent of the presence or absence of CKD.110 In their meta-analysis, Ettehad et al. 