Prepared by: The Diagnosis and Management of Hypertension in the Primary Care Setting Work Group With support from: The Office of Quality, Safety and Value, VA, Washington, DC & Office of Evidence Based Practice, U.S. Army Medical Command Based on evidence reviewed through March 2019 Table of Contents A. Epidemiology and Impact in the General Population 8 B. Hypertension in the Department of Defense and the Department of Veterans Affairs III. About this Clinical Practice Guideline 9 a. Grading Recommendations 10 b. Reconciling 2014 Clinical Practice Guideline Recommendations 12 c. Peer Review Process 12 B. Summary of Patient Focus Group Methods and Findings 13 C. Conflicts of Interest 14 D. Scope of this Clinical Practice Guideline 14 E. Highlighted Features of this Clinical Practice Guideline 15 F. Patient-centered Care 15 G. Shared Decision Making 15 H. Co-occurring Conditions 15 IV. Guideline Work Group 17 V. Algorithm 18 A. Module A: Screening and Diagnosis 19 B. Module B: Treatment 20 VII. Recommendations 23 A. Screening, Diagnosis, and Monitoring 26 b. Measurement Techniques 27 B. Treatment Goals and General Approaches to Hypertension Management 33 a. Blood Pressure Goals 33 b. General Approaches to Hypertension Management 39 C. Non-pharmacological Management 45 a. Weight Reduction 45 b. Exercise/Physical Activity 48 c. Dietary Modifications 50 D. Pharmacological Treatment 54 a. For Hypertension 54 b. For Resistant Hypertension 59 VIII. Research Priorities 62 A. Automated Office Blood Pressure and Out-of-office Blood Pressure 62 B. Self-monitoring of Blood Pressure 62 C. New Technology 62 D. Interdisciplinary Approaches 62 E. Diet and Exercise 62 F. Obesity and Hypertension 63 H. Screening for Asymptomatic Hypertension-mediated Target Organ Damage 63 Appendix A: Evidence Review Methodology 64 A. Developing the Scope and Key Questions 64 B. Conducting the Systematic Review 70 a. General Criteria for Inclusion in Systematic Review 74 b. 