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. Neither for nor against Reviewed, New-replaced b. For Resistant Hypertension 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. Weak for Reviewed, New-replaced a For additional information, please refer to Grading Recommendations. b For additional information, please refer to Recommendation Categorization and Appendix D. A. Screening, Diagnosis, and Monitoring a. Screening Recommendation 1. We recommend screening adults for elevated blood pressure periodically. (Strong for | Not Reviewed, Amended) Discussion A 2007 review of the evidence for the USPSTF describes the rationale for blood pressure screening.[29] Based on their review, the USPSTF concluded that the benefits of blood pressure screening far outweigh any risks. The risk for cardiovascular events and the potential benefit from screening and subsequent treatment of HTN depend on both the degree and duration of blood pressure elevation and the presence of other cardiovascular risk factors, such as age, gender, lipid disorders, smoking, and diabetes. Because the degree and duration of blood pressure elevation are unknown before screening, selective screening to identify individuals who would benefit most from detection and treatment of HTN would need to target individuals with other cardiovascular risk factors. The 2015 update from the USPSTF concluded that, given the strong evidence base for the previous recommendations, the indirect evidence path for HTN screening did not need updating.