However, patients with PAD typically comprise a small fraction of participants, so in the few trials that report results in patients with PAD, subgroup analyses are generally underpowered. Recommendation-Specific Supportive Text 1. There is no major difference in the relative risk re- duction in CVD from BP-lowering therapy between patients with hypertension and PAD and patients There is also no evidence that any one class of antihypertensive medication or strategy In the INVEST (International Verapamil-Trandolapril) study, the beta blocker at- enolol (with or without hydrochlorothiazide) was compared with the CCB verapamil (with or with- out perindopril). The study showed no significant difference in CVD outcomes between the 2 drug regimens in patients with and without PAD.S9.5-3 No trials have reported the effects of a higher ver- sus a lower BP goal in patients with PAD. In the 1 trial (ALLHAT) that reported the effects of different classes of BP medications on PAD as an outcome, there was no significant difference by medication Figure 9. Management of hypertension in patients with a previous history of stroke (secondary stroke prevention). Colors correspond to Class of Recommendation in Table 1. DBP indicates diastolic blood pressure; SBP, systolic blood pressure; and TIA, transient ischemic attack. 9.6. Diabetes Mellitus Recommendations for Treatment of Hypertension in Patients With DM References that support recommendations are summarized in Online Data Supplements 46 and 47 and Systematic Review Report. COR LOE Recommendations I SBP: B-RSR 1. In adults with DM and hypertension, antihypertensive drug treatment should be initiated at a BP of 130/80 mm Hg or higher with a treatment goal of less than 130/80 DBP: C-EO I ASR 2. In adults with DM and hypertension, all first- line classes of antihypertensive agents (ie, diuretics, ACE inhibitors, ARBs, and CCBs) are useful and effective.S9.6-1,S9.6-9,S9.6-10 IIb B-NR 3. 