In African American patients with hypertension, we recommend against using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker as monotherapy. Strong against [136-141] Strong against Reviewed, Not Changed 25. In hypertensive patients 65 years and over, we suggest a thiazide-type diuretic for reduction in composite cardiovascular outcomes. N/A [137,142-144] Weak for Reviewed, New- added Recommendation 2014 Strength of Recommendation Evidence 2020 Strength of Recommendation Recommendation Category 26. We recommend against more than one of the following three drug classes together in the same patient: angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or direct renin inhibitors. Strong against Additional References: Strong against Not Reviewed, Not Changed 27. For the treatment of hypertension, there is insufficient evidence to recommend for or against initiating combination therapy over initiating monotherapy with the sequential addition of another medication. Weak for Additional References: Neither for nor against Reviewed, New- replaced 28. For patients with resistant hypertension (defined as those who are not adequately controlled with maximally tolerated dose of triple therapy [i.e., a thiazide-type diuretic, calcium channel blockers, and angiotensin- converting enzyme inhibitor or angiotensin II receptor blocker]), we suggest adding spironolactone in those patients without contraindications. Strong for Additional References: Weak for Reviewed, New- replaced Appendix D: 2014 Recommendation Categorization Table Table D-1. 2014 Recommendation Categorization Tablea,b,c,d,e 2014 Recommendation Text 2014 Strength of Recommendation Recommendation Category Recommendation Section Number Page We recommend screening adults for elevated blood pressure occur periodically, preferably annually. (Modified from 2004 VA/DoD HTN CPG without an updated systematic review of the evidence.*) Strong for Not reviewed, Amended We suggest that screening occur at the time of routine preventive care or routine health assessment. (Modified from 2004 VA/DoD HTN CPG without an updated systematic review of the evidence.) 