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Adult aged >18 years with hypertension

Implement lifestyle interventions Continue throughout management).

Set blood pressure goal and inititate blood pressure lowering-medication based on age, diabetes, and cgronic kidney disease (CKD)

General population(no diabetes or CKD)

Diabetes or CKD present

Age > 60 years

Age < 60 years

All ages Diabetes present No CKD

All ages CKD present with or without diabetes

Blood pressure goal SBP < 150mm Hg DBP < 90mm Hg

Blood pressure goal SBP < 150mm Hg DBP < 90mm Hg

Blood pressure goal SBP < 150mm Hg DBP < 90mm Hg

Blood pressure goal SBP < 150mm Hg DBP < 90mm Hg

Nonblack

Black

All races

Initiate thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination.

Initiate thiazide-type diuretic or CCB, alone or in combination.

Initiate ACEI or ARB, alone or in combination with otherdrug class.

Select a drug treatment titration strategy A. Maximize first medication before adding second or B. Add second medication before reaching maximum dose of first medication or C. Start with 2 medication classes separately or as fixed-dose combination.

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. For strategies A and B, add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class not previously selected and avoid combined use of ACEI and ARB). For strategy C, titrate doses of initial medications to maximum.

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. Add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class not previously selected and avoid combined use of ACEI and ARB).

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. Add additional medication class (eg, β-blocker, aldosterone antagonist, or others) and/or refer to physician with expertise in hypertension management.

No

At goal blood pressure?

Yes