In addition, the ability to compare studiesfromdifferenttimeperiodswaslimitedbydifferencesinclini- cal trial design and analytic techniques. While physicians use cost, adherence, and often observational data to make treatment decisions, medical interventions should wheneverpossiblebebasedfirstandforemostongoodsciencedem- onstratingbenefitstopatients.Randomizedcontrolledtrialsarethe gold standard for this assessment and thus were the basis for pro- vidingtheevidenceforourclinicalrecommendations.Althoughad- verse effects and harms of antihypertensive treatment docu- mented in the RCTs were considered when the panel made its decisions, the review was not designed to determine whether therapy-associated adverse effects and harms resulted in signifi- cantchangesinimportanthealthoutcomes.Inaddition,thisguide- line was not endorsed by any federal agency or professional soci- ety prior to publication and thus is a departure from previous JNC reports. The panel anticipates that an objective assessment of this reportfollowingpublicationwillallowopendialogueamongendors- Table 5. Strategies to Dose Antihypertensive Drugs Strategy Description Details A Start one drug, titrate to maximum dose, and then add a second drug If goal BP is not achieved with the initial drug, titrate the dose of the initial drug up to the maximum recommended dose to achieve goal BP If goal BP is not achieved with the use of one drug despite titration to the maximum recommended dose, add a second drug from the list (thiazide-type diuretic, CCB, ACEI, or ARB) and titrate up to the maximum recommended dose of the second drug to achieve goal BP If goal BP is not achieved with 2 drugs, select a third drug from the list (thiazide-type diuretic, CCB, ACEI, or ARB), avoiding the combined use of ACEI and ARB. 