For strategy C, titrate doses of initial medications to maximum. Reinforce medication and lifestyle adherence. Add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class not previously selected and avoid combined use of ACEI and ARB). Reinforce medication and lifestyle adherence. Add additional medication class (eg, -blocker, aldosterone antagonist, or others) and/or refer to physician with expertise in hypertension management. Continue current treatment and monitoring.b Black All races Nonblack Age 60 years Blood pressure goal SBP <150 mm Hg DBP <90 mm Hg Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg Age <60 years Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg All ages Diabetes present No CKD Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg All ages CKD present with or without diabetes At goal blood pressure? No Yes At goal blood pressure? No Yes At goal blood pressure? No Yes Yes No Initiate thiazide-type diuretic or CCB, alone or in combination. Initiate thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination.a Initiate ACEI or ARB, alone or in combination with other drug class.a Set blood pressure goal and initiate blood pressure lowering-medication based on age, diabetes, and chronic kidney disease (CKD). Implement lifestyle interventions (continue throughout management). Diabetes or CKD present General population (no diabetes or CKD) At goal blood pressure? SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ACEI, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; and CCB, calcium channel blocker. a ACEIs and ARBs should not be used in combination. b If blood pressure fails to be maintained at goal, reenter the algorithm where appropriate based on the current individual therapeutic plan. 