The new blood pressure guidelines stress that people at higher risk of future harmful events should be treated more aggressively. More widespread use of this concept would lead to more effective and less costly care for many conditions. In fact, we already use this risk-based care approach in other clinical situations. For example, treatment recommendations for high cholesterol, asthma and reduced bone mineral density are based on future risk. We could easily broaden this approach to how we treat other conditions, such as diabetes and bronchitis. The downside, of course, is that we need to give up the simplicity of a one-size-fits-all approach. In addition, if we understand that our true goal is to reduce future risk, this implies that we need to treat all of the factors that contribute to high risk. For example, if we are really “treating” the future risk of stroke and heart attack, we should emphasize lifestyle changes and simultaneously consider blood pressure medicines, statins and aspirin.