The panel also acknowledged that the evidence supported BP control, rather than a specific agent used to achieve thatcontrol,asthemostrelevantconsiderationforthisrecommen- dation. The panel did not recommend -blockers for the initial treat- ment of hypertension because in one study use of -blockers re- sulted in a higher rate of the primary composite outcome of cardio- vascular death, myocardial infarction, or stroke compared to use of an ARB, a finding that was driven largely by an increase in stroke Intheotherstudiesthatcom- performed similarly to the other drugs (question 3, evidence state- ment 8) or the evidence was insufficient to make a determination (question 3, evidence statements 7, 12, 21, 23, and 24). -Blockers were not recommended as first-line therapy be- cause in one study initial treatment with an -blocker resulted in worse cerebrovascular, heart failure, and combined cardiovascular outcomes than initial treatment with a diuretic (question 3, evi- dence statement 13).29 There were no RCTs of good or fair quality dual 1- + -blocking agents (eg, carvedilol), vasodilating -block- rect vasodilators (eg, hydralazine), aldosterone receptor antago- nists(eg,spironolactone),peripherallyactingadrenergicantagonists (reserpine), and loop diuretics (eg, furosemide) (question 3, evi- mendedasfirst-linetherapy.Inaddition,noeligibleRCTswereiden- tified that compared a diuretic vs an ARB, or an ACEI vs an ARB. ONTARGET was not eligible because hypertension was not re- quired for inclusion in the study.30 Similar to those for the general population, this recommenda- tion applies to those with diabetes because trials including partici- pants with diabetes showed no differences in major cardiovascular or cerebrovascular outcomes from those in the general population (question 3, evidence statements 36-48). 2014 Guideline for Management of High Blood Pressure Special Communication Clinical Review & Education jama.com JAMA Published online December 18, 2013 E7 The following important points should be noted. First, many people will require treatment with more than one antihyperten- sive drug to achieve BP control. 