The research supporting the goal of SBP <130 mm Hg in the general HTN population, with or without diabetes, is less robust than higher thresholds, which, according to our methodology, resulted in a weaker recommendation for this SBP goal. As this is a Reviewed, New-added recommendation, the Work Group systematically reviewed evidence related to this recommendation to treat hypertensive adults, including those with type 2 diabetes, to an SBP goal of less than 130 mm Hg. [54-57,59-61] The Work Group s confidence in the quality of the evidence is moderate. For people with an SBP above 130 mm Hg, a further 10 mm Hg reduction in SBP was associated with improved cardiovascular outcomes. There is some inconsistency in the data, as SRs that only compared a standard threshold to a more intensive threshold reached contradictory conclusions. However, there were different inclusion criteria and methods across the SRs. The benefit of improved cardiovascular outcomes outweighs the potential harm of AEs; however, patients may or may not be accepting of HTN medication therapy.[63] Some patients are concerned over AEs of medication and may indicate that they want to avoid or limit use of medications, when possible. Patients, however, may be more likely to accept medications with SDM and careful titration. Based on the above, the Work Group decided upon a Weak for recommendation. Additional RCTs would be needed to definitively recommend an SBP target of less than 130 mm Hg. Given the results of SPRINT, such a large clinical trial is unlikely to be performed in the U.S. in a general (lower risk) hypertensive population. Ongoing clinical trials from other countries that mirror the SPRINT protocol, or conducted among hypertensive patients excluded from or not robustly represented in SPRINT, could provide additional evidence. 