, patients with SBP/DBP of >20/10 mm Hg above goal), consider initiating treatment with combination therapy or monotherapy with close follow up for titration and/or addition of medications based on blood pressure response Specific Populations: For patients age 65 and over, we suggest a thiazide-type diuretic for reduction in composite cardiovascular outcomes For African American patients, we recommend against using ACEIs or ARBs as monotherapy For patients with CKD, see VA/DoD CKD CPG1 *We recommend against more than one of the following three drug classes together in the same patient: ACEIs, ARBs, or direct renin inhibitors Sidebar 3: Examples of Target Organ Damage and Comorbid Conditions* Target organ damage: stroke, MI, peripheral arterial disease, LVH, CHF, CKD, and retinopathy Comorbid conditions: CKD, dyslipidemia, diabetes, obesity/overweight, OSA, and tobacco dependence *If patient has comorbid conditions, engage relevant clinical practice guidelines, 1. See the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease. Available at: https://www.healthquality.va.gov/guidelines/CD/CKD/ 2. See the VA/DoD Clinical Practice Guideline for the Management of Dyslipidemia for Cardiovascular Risk Reduction. Available at: https://www.healthquality.va.gov/guidelines/CD/lipids/ 3. See the VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care. Available at: https://www.healthquality.va.gov/guidelines/CD/diabetes/ 4. See the VA/DoD Clinical Practice Guideline for Screening and Management of Obesity and Overweight. 