For patients younger than 60 years, clinicians should initiate pharmacologic treatment if diastolic blood pressure is 90 mmHg or higher. For patients with chronic kidney disease or diabetes, antihypertensive drugs should be used when systolic blood pressure is 140 mmHg or higher, or when diastolic blood pressure is 90 mmHg or higher.

Patients who are not African American, including those with diabetes, should receive a thiazide-type diuretic, a calcium channel blocker, an angiotensin converting enzyme inhibitor (ACE inhibitors), or an angiotensin receptor blockers (ARB) as initial therapy. Initial therapy for African American patients should include only a thiazide-type diuretic or a calcium channel blocker. Those with chronic kidney disease should receive initial or add-on antihypertensive treatment with an ACE inhibitor or an ARB, regardless of race or diabetes status.

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If target blood pressure is not reached within 1 month of antihypertensive therapy, increase the dose of the initial drug, or add a second drug from 1 of these classes: thiazide-type diuretic, calcium channel blocker, ACE inhibitor, or ARB.

Blood pressure should be monitored continually; the treatment regimen should be adjusted until target blood pressure is reached. A third drug can be added and titrated if goal blood pressure cannot be attained with 2 drugs.

Clinicians should not use an ACE inhibitor and an ARB together.


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