However, in both ACCORD and SPRINT, 2-drug therapy was recommended for most partici- pants in the intensive- but not standard-therapy groups. Recommendation-Specific Supportive Text 1. Because most patients with hypertension require multiple agents for control of their BP and those with higher BPs are at greater risk, more rapid titration of antihyperten- sive medications began to be recommended in patients with BP >20/10 mm Hg above their target, beginning with the JNC 7 report.S8.1.6.1-1 In these patients, initiation of antihypertensive therapy with 2 agents is recommend- ed. Evidence favoring this approach comes mostly from studies using fixed-dose combination products show- ing greater BP lowering with fixed-dose combination agents than with single agents, as well as better adher- ence to therapy.S8.1.6.1-2,S8.1.6.1-3 The safety and efficacy of this strategy have been demonstrated in adults to reduce BPs to <140/90 mm Hg though not compared with other In general, this approach is rea- sonable in older adults, those at high CVD risk, or those who have a history of hypotension or drug-associated side effects. However, caution is advised in initiating antihypertensive pharmacotherapy with 2 drugs in older patients because hypotension or orthostatic hypotension may develop in some patients; BP should be carefully monitored. 2. The stepped-care approach defined by the initiation of an- tihypertensive drug therapy with a single agent followed by the sequential titration of the dose and addition of oth- er agents has been the recommended treatment strategy since the first report of the National High Blood Pressure This approach is also reason- able in older adults or those at risk or who have a history of hypotension or drug-associated side effects. 