Therapeutic classes are not recommended because potential toxicity differs among agents within classes. 2. ACE inhibitors and ARBs are fetotoxic in the second and third trimesters of pregnancy. Adverse effects in the first trimester of pregnancy may be secondary to hypertension or the medication.S10.2.2-4,S10.2.2-5 Adverse events in the later trimesters have been suggested by observational data and For ARBs, case reports with effects similar to ACE inhibitors have been published.S10.2.2-19 10.3. Age-Related Issues 10.3.1. Older Persons Recommendations for Treatment of Hypertension in Older Persons References that support recommendations are summarized in Online Data Supplement 54. COR LOE Recommendations I A 1. Treatment of hypertension with a SBP treatment goal of less than 130 mm Hg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 years of age) with an average SBP of 130 mm Hg or higher.S10.3.1-1 IIa C-EO 2. For older adults ( 65 years of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/ benefit is reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. 