In black adults with hypertension but without HF or CKD, including those with DM, initial antihypertensive treatment should include a thiazide-type diuretic or I C-LD 2. Two or more antihypertensive medications are recommended to achieve a BP target of less than 130/80 mm Hg in most adults with hypertension, especially in black adults with Synopsis Lifestyle modification (ie, weight reduction, dietary modifica- tion, and increased physical activity) is particularly important in blacks and Hispanic Americans for prevention and first-line or adjunctive therapy of hypertension (see Sections 12.1.2 and 12.1.3). However, the adoption of lifestyle recommendations is often challenging in ethnic minority patients because of poor social support, limited access to exercise opportunities and healthy foods, and financial considerations. The greater prev- alence of lower socioeconomic status may impede access to basic living necessities,S10.1.1-8 including medical care and medi- cations. Consideration must also be given to learning styles and preference, personal beliefs, values, and culture.S10.1.1-9,S10.1.1-10 The principles of antihypertensive drug selection discussed in Sections 8.1.4 through 8.1.6 apply to ethnic minorities with a few caveats. In blacks, thiazide-type diuretics and CCBs are more effective in lowering BP when given as monother- apy or as initial agents in multidrug regimens.S10.1.1-11 S10.1.1-13 In addition, thiazide-type agents are superior to drugs that inhibit the RAS (ie, ACE inhibitors, ARBs, renin inhibitors, and beta blockers) for prevention of selected clinical out- comes in blacks.S10.1.1-2,S10.1.1-14 S10.1.1-16 For optimum endpoint protection, the thiazide chlorthalidone should be administered at a dose of 12.5 to 25 mg/day (or 25 50 mg/d for hydro- chlorothiazide) because lower doses are either unproven or less effective in clinical outcome trials.S10.1.1-2,S10.1.1-16 The CCB amlodipine is as effective as chlorthalidone and more effective than the ACE inhibitor lisinopril in reducing BP, CVD, and stroke events but less effective in preventing HF. 