Systolic Blood Pressure Intervention Trial

Inclusion Criteria: * At least 50 years old Systolic blood pressure of * 130 - 180 mm Hg on 0 or 1 medication * 130 - 170 mm Hg on up to 2 medications * 130 - 160 mm Hg on up to 3 medications * 130 - 150 mm Hg on up to 4 medications Risk (one or more of the following) 1. Presence of clinical or subclinical cardiovascular disease other than stroke 2. CKD, defined as eGFR 20 - 59 ml/min/1.73m2 3. A Framingham Risk Score for 10-year CVD risk ≥ 15% 4. Age greater than 75 years Exclusion Criteria: * An indication for a specific BP lowering medication that the person is not taking and the person has not been documented to be intolerant of the medication class. * Known secondary cause of hypertension that causes concern regarding safety of the protocol. * One minute standing SBP \< 110 mm Hg. * Proteinuria in the following ranges (based on a measurement within the past 6 months) * 24 hour urinary protein excretion ≥1 g/day, or * 24 hour urinary albumin excretion ≥ 600 mg/day, or * spot urine protein/creatinine ratio ≥ 1 g/g creatinine, or * spot urine albumin/creatinine ratio ≥ 600 mg/g creatinine, or * urine dipstick ≥ 2+ protein * Arm circumference too large or small to allow accurate blood pressure measurement with available devices * Diabetes mellitus, * History of stroke (not CE or stenting) * Diagnosis of polycystic kidney disease * Glomerulonephritis treated with or likely to be treated with immunosuppressive therapy * eGFR \< 20 ml/min /1.73m2 or end-stage renal disease (ESRD) * Cardiovascular event or procedure (as defined above as clinical CVD for study entry) or hospitalization for unstable angina within last 3 months * Symptomatic heart failure within the past 6 months or left ventricular ejection fraction (by any method) \< 35% * A medical condition likely to limit survival to less than 3 years or a malignancy other than non-melanoma skin cancer within the last 2 years * Any factors judged by the clinic team to be likely to limit adherence to interventions. * Failure to obtain informed consent from participant * Currently participating in another clinical trial (intervention study). Note: Patient must wait until the completion of his/her activities or the completion of the other trial before being screened for SPRINT. * Living in the same household as an already randomized SPRINT participant * Any organ transplant * Unintentional weight loss \> 10% in last 6 months * Pregnancy, currently trying to become pregnant, or of child-bearing potential and not using birth control.