It is important to note that the age of 65 is an arbitrary cut-off that was used in this single meta-analysis. Individual trials have used various age cut-offs for enrollment. Furthermore, this meta-analysis reported similar outcomes with an age cut-off of 60, as compared to 65. Large RCTs are consistent with this recommendation, specifically ALLHAT which is especially pertinent to VA/DoD providers due to the more than 7,000 Veterans included in the study.[137] Of note, ALLHAT enrolled patients age 55 and over and demonstrated improved CVD outcomes with chlorthalidone compared to amlodipine or lisinopril. Harms of thiazide-type diuretics versus other therapies were considered, but a meta-analysis of adverse events did not demonstrate any significant difference between thiazide-type diuretics and other therapies.[142] In general, the evidence supports the use of thiazide-type diuretics in older patients with HTN over other classes of medication. While there is strong evidence that thiazide-type diuretics in general reduce a composite cardiovascular outcome, there is significant variability between agents in the thiazide-type diuretic class. The strongest trial evidence for improved CVD outcomes with thiazide-type diuretics involves chlorthalidone and indapamide, from ALLHAT and the Hypertension in the Very Elderly Trial (HYVET), respectively.[137,143] In Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH), ACEI/CCB combination was favored over an ACEI/thiazide-type diuretic combination.[144] The dose and type of the thiazide-type diuretic in ACCOMPLISH (hydrochlorothiazide [HCTZ] 12.5-25 mg/day) was lower than equipotent doses of chlorthalidone or indapamide. For initial or add-on treatment of HTN, chlorthalidone and indapamide result in greater decreases of blood pressure compared to low doses (12.5-25 mg/day) of HCTZ. For these reasons, chlorthalidone or indapamide is preferred over HCTZ when choosing a thiazide-type diuretic. Patient preferences may vary based on the requirement for laboratory monitoring with thiazide-type medications. 