In fact, BP-lowering therapy is one of the few inter- ventions shown to reduce mortality risk in frail older indi- viduals. RCTs in noninstitutionalized community-dwelling older persons have also demonstrated that improved BP con- trol does not exacerbate orthostatic hypotension and has no adverse impact on risk of injurious falls.S10.3.1-1,S10.3.1-15,S10.3.1-16 It should be noted, however, that SPRINT excluded those with low (<110 mm Hg) standing BP on study entry. Older persons need to be carefully monitored for orthostatic hypotension during treatment. Intensive BP control increases the risk of acute kidney injury, but this is no different from the risk seen in younger adults.S10.3.1-1 In summary, despite the complexity of management in caring for older persons with hypertension, RCTs have demonstrated that in many community-dwelling older adults, even adults >80 years of age, BP-lowering goals during antihypertensive treatment need not differ from those selected for persons <65 years of age.S10.3.1-17 Importantly, no randomized trial of BP lowering in persons >65 years of age has ever shown harm or less benefit for older versus younger adults. However, clinicians should implement careful titra- tion of BP lowering and monitoring in persons with high comorbidity burden; large RCTs have excluded older persons at any age who live in nursing homes, as well as those with prevalent dementia and advanced HF. Recommendation-Specific Supportive Text 1. We recommend ASCVD risk assessment in all adults with hypertension, including older persons. As a mat- ter of convenience, however, it can be assumed that the vast majority of older adults have a 10-year ASCVD risk 10%, placing them in the high risk category that requires initiation of antihypertensive drug therapy at BP 130/80 mm Hg (see Section 8.1.2, Figure 4 and Table 23 for BP thresholds for initiating antihypertensive drug treatment). 