For example, there are no good- or fair-qualityRCTswithmortalityasaprimaryorsecondaryprespeci- fied outcome that compared a DBP goal of lower than 90 mm Hg with a lower goal (evidence statement 21). IntheHOTtrial,whichisfrequentlycitedtosupportalowerDBP goal, investigators compared a DBP goal of 90 mm Hg or lower vs a goal of 80 mm Hg or lower.19 The lower goal was associated with a of the study population that was not prespecified. As a result, the evidence was graded as low quality. Another commonly cited study to support a lower DBP goal is which had a BP goal of lower than 150/85 mm Hg in the more-intensivelytreatedgroupcomparedwithagoaloflowerthan 180/105 mm Hg in the less-intensively treated group. UKPDS did showthattreatmentinthelowergoalBPgroupwasassociatedwith asignificantlylowerrateofstroke,heartfailure,diabetes-relatedend points,anddeathsrelatedtodiabetes.However,thecomparisonin UKPDS was a DBP goal of lower than 85 mm Hg vs lower than105 mm Hg; therefore, it is not possible to determine whether treat- ment to a DBP goal of lower than 85 mm Hg improves outcomes compared with treatment to a DBP goal of lower than 90 mm Hg. In addition, UKPDS was a mixed systolic and diastolic BP goal study (combined SBP and DBP goals), so it cannot be determined if the benefits were due to lowering SBP, DBP, or both. In the general nonblack population, including those with diabetes, initialantihypertensivetreatmentshouldincludeathiazide-typedi- uretic, calcium channel blocker (CCB), angiotensin-converting en- zyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). Moderate Recommendation Grade B For this recommendation, only RCTs that compared one class of antihypertensive medication to another and assessed the effects on health outcomes were reviewed; placebo-controlled RCTs were not included. 