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. This strat- egy has been used successfully in nearly all hypertension treatment trials but has not been formally tested against other antihypertensive drug treatment strategies for effec- tiveness in achieving BP control or in preventing adverse outcomes. 8.2. Achieving BP Control in Individual Patients Recommendations for lifestyle modifications and drug selec- tion are specified in Sections 6.2, 8.1.4, and 8.1.6. Initial drug selections should be based on trial evidence of treatment effi- cacy, combined with recognition of compelling indications for use of an agent from a specific drug class, as well as the indi- vidual patient s lifestyle preferences and traits. For a subset of the initial drug therapy will be well tolerated and effective in achieving the desired level of BP, with only the need for subsequent monitoring (see Section 8.3 for an appropriate follow-up schedule). For others, the initial drug will not be tolerated or will not be effective, requiring either a change in medication or addition of another medi- cation, followed by BP monitoring.S8.2-2 of patients will require additional treatment adjustments. In a minority of this group, achievement of goal BP can be challenging. In patients who do not respond to or do not tolerate treat- ment with 2 to 3 medications or medication combinations, additional trials of treatment tend to be ineffective or poorly tolerated. 