***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Recent reports have drawn attention to the importance of pulse pressure as a predictor of cardiovascular events .  Pulse pressure is used neither by clinicians nor by guidelines to define treatable levels of blood pressure . METHODS In the Cardiovascular Health Study , 5888 adults 65 years and older were recruited from 4 US centers . At baseline in 1989 - 1990 , participants underwent an extensive examination , and all subsequent cardiovascular events were ascertained and classified . RESULTS At baseline , 1961 men and 2941 women were at risk for an incident myocardial infa rct ion or stroke . During follow-up that averaged 6.7 years , 572 subjects had a coronary event , 385 had a stroke , and 896 died . After adjustment for potential confounders , systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and pulse pressure were directly associated with the risk of incident myocardial infa rct ion and stroke . Only SBP was associated with total mortality . Importantly , SBP was a better predictor of cardiovascular events than DBP or pulse pressure . In the adjusted model for myocardial infa rct ion , a 1-SD change in SBP , DBP , and pulse pressure was associated with hazard ratios ( 95 % confidence intervals ) of 1.24 ( 1.15 - 1.35 ) , 1.13 ( 1.04 - 1.22 ) , and 1.21 ( 1.12 - 1.31 ) , respectively ; and adding pulse pressure or DBP to the model did not improve the fit . For stroke , the hazard ratios ( 95 % confidence intervals ) were 1.34 ( 1.21 - 1.47 ) with SBP , 1.29 ( 1.17 - 1.42 ) with DBP , and 1.21 ( 1.10 - 1.34 ) with pulse pressure . The association between blood pressure level and cardiovascular disease risk was generally linear ; specifically , there was no evidence of a J-shaped relationship . In those with treated hypertension , the hazard ratios for the association of SBP with the risks for myocardial infa rct ion and stroke were less pronounced than in those without treated hypertension . CONCLUSION In this population -based study of older adults , although all measures of blood pressure were strongly and directly related to the risk of coronary and cerebrovascular events , SBP was the best single predictor of cardiovascular events Elevated blood pressure ( BP ) is a causal risk factor for cardiovascular disease ( CVD ) . Epidemiological analyses have established the grade d and continuous association between higher BP and CVD . Moreover , r and omized clinical trials among individuals with hypertension have demonstrated , in aggregate , a reduction in CVD events by 20 % , coronary heart disease ( CHD ) by 17 % , stroke by 27 % , and heart failure by 28 % for every 10 mm Hg systolic BP ( SBP ) lowering with medical therapy.1 Therefore , prevention , detection , treatment , and control of elevated BP , and its clinical correlate hypertension , is an important public health priority and a primary target for CVD prevention . Although national health surveys have demonstrated improvements in hypertension awareness and treatment , strategic opportunities to improve the efficiency and efficacy of applying BP-lowering therapy in patients most likely to benefit remain.2 Global CVD risk assessment , using multivariable prediction models that estimate absolute CVD risk from routinely measured clinical variables , has been promulgated in several CVD prevention guidelines for cholesterol management to target the most intensive preventive therapies to those at highest absolute CVD risk.3–5 Hypertension guidelines , however , have instead relied solely on isolated BP thresholds and BP goals to guide treatment initiation and intensity . In this review , we provide a rationale for incorporating global CVD risk assessment in BP treatment decision-making and propose a framework to guide its implementation in future CVD prevention guidelines . Epidemiological analyses have firmly established that CVD is a multifactorial condition and that modest increases of several CVD risk factors can often lead to greater overall risk than a severe elevation of a OBJECTIVE To determine whether the effects of intensive ( < 120 mmHg ) compared with st and ard ( < 140 mmHg ) systolic blood pressure ( SBP ) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial ( SPRINT ) . RESEARCH DESIGN AND METHODS This was a post hoc analysis of SPRINT . SPRINT participants were categorized by prediabetes status , defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia ( fasting serum glucose < 100 mg/dL ) . The primary outcome was a composite of myocardial infa rct ion , acute coronary syndrome not result ing in myocardial infa rct ion , stroke , acute decompensated heart failure , or death from cardiovascular causes . Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with st and ard SBP treatment among those with prediabetes and normoglycemia . RESULTS Among 9,361 participants r and omized ( age 67.9 ± 9.4 years ; 35.5 % female ) , 3,898 and 5,425 had baseline prediabetes and normoglycemia , respectively . After a median follow-up of 3.26 years , the hazard ratio for the primary outcome was 0.69 ( 95 % CI 0.53 , 0.89 ) and 0.83 ( 95 % CI 0.66 , 1.03 ) among those with prediabetes and normoglycemia , respectively ( P value for interaction 0.30 ) . For all-cause mortality , the hazard ratio with intensive SBP treatment was 0.77 ( 95 % CI 0.55 , 1.06 ) for prediabetes and 0.71 ( 95 % CI 0.54 , 0.94 ) for normoglycemia ( P value for interaction 0.74 ) . Effects of intensive versus st and ard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia ( all interaction P > 0.05 ) . CONCLUSIONS In SPRINT , the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain . METHODS We r and omly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk , but without diabetes , to a systolic blood-pressure target of less than 120 mm Hg ( intensive treatment ) or a target of less than 140 mm Hg ( st and ard treatment ) . The primary composite outcome was myocardial infa rct ion , other acute coronary syndromes , stroke , heart failure , or death from cardiovascular causes . RESULTS At 1 year , the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the st and ard-treatment group . The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the st and ard-treatment group ( 1.65 % per year vs. 2.19 % per year ; hazard ratio with intensive treatment , 0.75 ; 95 % confidence interval [ CI ] , 0.64 to 0.89 ; P<0.001 ) . All-cause mortality was also significantly lower in the intensive-treatment group ( hazard ratio , 0.73 ; 95 % CI , 0.60 to 0.90 ; P=0.003 ) . Rates of serious adverse events of hypotension , syncope , electrolyte abnormalities , and acute kidney injury or failure , but not of injurious falls , were higher in the intensive-treatment group than in the st and ard-treatment group . CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes , targeting a systolic blood pressure of less than 120 mm Hg , as compared with less than 140 mm Hg , result ed in lower rates of fatal and nonfatal major cardiovascular events and death from any cause , although significantly higher rates of some adverse events were observed in the intensive-treatment group . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT01206062 . ) BACKGROUND Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown . We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke . METHODS In this r and omised open-label trial , eligible patients lived in North America , Latin America , and Spain and had recent , MRI-defined symptomatic lacunar infa rct ions . Patients were recruited between March , 2003 , and April , 2011 , and r and omly assigned , according to a two-by-two multifactorial design , to a systolic-blood-pressure target of 130 - 149 mm Hg or less than 130 mm Hg . The primary endpoint was reduction in all stroke ( including ischaemic strokes and intracranial haemorrhages ) . Analysis was done by intention to treat . This study is registered with Clinical Trials.gov , number NCT 00059306 . FINDINGS 3020 enrolled patients , 1519 in the higher-target group and 1501 in the lower-target group , were followed up for a mean of 3·7 ( SD 2·0 ) years . Mean age was 63 ( SD 11 ) years . After 1 year , mean systolic blood pressure was 138 mm Hg ( 95 % CI 137 - 139 ) in the higher-target group and 127 mm Hg ( 95 % CI 126 - 128 ) in the lower-target group . Non-significant rate reductions were seen for all stroke ( hazard ratio 0·81 , 95 % CI 0·64 - 1·03 , p=0·08 ) , disabling or fatal stroke ( 0·81 , 0·53 - 1·23 , p=0·32 ) , and the composite outcome of myocardial infa rct ion or vascular death ( 0·84 , 0·68 - 1·04 , p=0·32 ) with the lower target . The rate of intracerebral haemorrhage was reduced significantly ( 0·37 , 0·15 - 0·95 , p=0·03 ) . Treatment-related serious adverse events were infrequent . INTERPRETATION Although the reduction in stroke was not significant , our results support that in patients with recent lacunar stroke , the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial . FUNDING National Institutes of Health-National Institute of Neurological Disorders and Stroke ( NIH-NINDS ) We aim ed to investigate the relationship of time-averaged on-treatment systolic blood pressure ( SBP ) with the risk of first stroke in the CSPPT ( China Stroke Primary Prevention Trial ) . A post hoc analysis was conducted using data from 17 720 hypertensive adults without cardiovascular disease , diabetes mellitus , and renal function decline from the CSPPT , a r and omized double-blind controlled trial . The primary outcome was first stroke . Over a median follow-up duration of 4.5 years , the association between averaged on-treatment SBP and risk for first stoke followed a U-shape curve , with increased risk above and below the reference range of 120 to 130 mm Hg . Compared with participants with time-averaged on-treatment SBP at 120 to 130 mm Hg ( mean , 126.2 mm Hg ) , the risk of first stroke was not only increased in participants with SBP at 130 to 135 mm Hg ( mean , 132.6 mm Hg ; 1.5 % versus 0.8 % ; hazard ratio , 1.63 ; 95 % confidence interval , 1.01–2.63 ) or 135 to 140 mm Hg ( mean , 137.5 mm Hg ; 1.9 % versus 0.8 % ; hazard ratio , 1.85 ; 95 % confidence interval , 1.17–2.93 ) , but also increased in participants with SBP < 120 mm Hg ( mean , 116.7 mm Hg ; 3.1 % versus 0.8 % ; hazard ratio , 4.37 ; 95 % confidence interval , 2.10–9.07 ) . Similar results were found in various subgroups stratified by age , sex , and treatment group . Furthermore , lower diastolic blood pressure was associated with lower risk of stroke , with a plateau at a time-average on-treatment diastolic blood pressure < 80 mm Hg . In conclusion , among adults with hypertension and without a history of stroke or myocardial 
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Further , a meta- analysis of 147 RCTs of antihypertensive therapy the percentage reduction in stroke with BP reduction down to a mean of 110/70 mm Hg regardless of their BP before treatment.8 Another systematic review in patients with diabetes mellitus reported a decrease of 13 % in the risk of stroke for each 5 mm Hg reduction in SBP , and by 11.5 % for each 2 mm Hg reduction in diastolic BP.9 In another meta- analysis of 123 studies , Ettehad et al4 provided support for lowering SBP to