In blacks, thiazide diuretics or CCBs are more effective in lowering BP than are RAS inhibitors or beta block- ers and more effective in reducing CVD events than are RAS inhibitors or alpha blockers. RAS inhibitors are recommended in black patients with hypertension, DM, and nephropathy, but they offer no advantage over diuret- ics or CCBs in hypertensive patients with DM without nephropathy or HF. 2. Four drug classes (thiazide diuretic, CCB, ACE inhibi- tor, or ARB) lower BP and reduce cardiovascular or re- Thus, except for the combi- nation of ACE inhibitors and ARBs, regimens containing a combination of these classes are reasonable to achieve the BP target.S10.1.1-16,S10.1.1-21 Furthermore, the combina- tion of an ACE inhibitor or ARB with a CCB or thia- zide diuretic produces similar BP lowering in blacks as in other racial or ethnic groups. For blacks who do not achieve control with 3 drugs, see resistant hypertension (see Section 11.1). 10.2. Sex-Related Issues The prevalence of hypertension is lower in women than in men until about the fifth decade but is higher later in life.S10.2-1 Other than special recommendations for management of hyperten- sion during pregnancy, there is no evidence that the BP thresh- old for initiating drug treatment, the treatment target, the choice of initial antihypertensive medication, or the combina- tion of medications for lowering BP differs for women versus A potential limitation of RCTs, including SPRINT, is that they are not specifically powered to determine the value of inten- sive SBP reduction in subgroups, including women in the case of SPRINT. However, in prespecified analyses, there was no evidence of an interaction between sex and treatment effect. 