OBJECTIVES: Results from the recent SPRINT trial demonstrate lower rates of fatal and non-­fatal major cardiovascular events and all-­cause mortality in non-­diabetics at high cardiovascular risk with intensive versus standard treatment, i.e., less than 120 versus less than 140 mmHg systolic, respectively. However, the long-­term outcomes remain unknown. METHODS: A validated state ­transition model with multivariate risk equations was populated with the baseline characteristics of the SPRINT trial, and cost and health-­related quality of life data for the United States. Model projections, based on trial-­observed blood pressures, were compared to actual median follow­-up trial results for calibration. To assess long-­term outcomes, we projected 20-­year incidence in myocardial infarctions, strokes, heart failure, and end­stage renal disease, and derived relative risks and numbers needed to treat (NNT). Direct medical costs and incremental cost-effectiveness ratio (ICER in $/quality adjusted life year [QALY]), discounted at 3% p.a., were computed for both strategies. RESULTS:  The calibrated model outcomes matched the published SPRINT trial results at a median follow­up of 39 months. Over the 20-­year horizon, intense blood pressure control was projected to lead to lower incidences of all studied events; NNTs varied largely between clinical events such as heart failure (696) and cardiovascular and all-cause death (28 and 11, respectively). Life expectancy increased by 2.5 years (85.8 vs. 83.3 years), at similar discounted lifetime costs of about $47K and an ICER of $15,901/QALY. CONCLUSIONS: Our model-­based projections suggest intensive blood pressure control in non­diabetics at high cardiovascular risk is associated with significant long­term benefits. Numbers needed to prevent mortality are particularly attractive. Cost savings seem to be consumed by additional life expectancy. Patient­-level data analysis via bootstrapping is necessary to quantify the uncertainty.