The Systolic Blood Pressure Intervention Trial (SPRINT) showed that in high risk patients, intensive systolic blood pressure treatment reduced cardiovascular disease risk and all-cause mortality compared to standard treatment. Given that 16.8 million U.S. adults are high risk and meet SPRINT eligibility for intensive systolic blood pressure treatment, and the added costs of delivering intensive treatment, there is need for an approach to selecting the highest value patients for intensive systolic blood pressure treatment. In this study, we will apply randomized clinical trials, epidemiology, biostatistics, health economic evaluation, and decision analysis methods to develop a clinical decision tool that will identify for health care providers, private health care system and government payers the patients in whom intensive systolic blood pressure treatment will most likely reduce cardiovascular disease risk safely and cost-effectively.