When ini- tiation of pharmacological therapy with a single medication is appropriate, primary consideration should be given to comor- bid conditions (eg, HF, CKD) for which specific classes of BP-lowering medication are indicated (see Section 9).S8.1.6-1 In the largest head-to-head comparison of first-step drug therapy the thiazide-type diuretic chlorthalidone was superior to the CCB amlodipine and the ACE inhibitor lisinopril in preventing HF, a BP-related outcome of increas- ing importance in the growing population of older persons with Additionally, ACE inhibitors were less effective than thiazide diuretics and CCBs in lowering BP and in prevention of stroke. For black patients, ACE inhibitors were also notably less effective than CCBs in preventing HFS8.1.6-8 and in the prevention of strokeS8.1.6-9 (see Section 10.1).ARBs may be better tolerated than ACE inhibitors in black patients, with less cough and angioedema, but according to the limited available experience they offer no proven advantage over ACE inhibitors in preventing stroke or CVD in this population, making thiazide diuretics (especially chlorthalidone) or CCBs the best initial choice for single-drug therapy. For stroke, in the general popula- tion, beta blockers were less effective than CCBs (36% lower risk) and thiazide diuretics (30% lower risk). CCBs have been shown to be as effective as diuretics for reducing all CVD events other than HF, and CCBs are a good alternative choice for initial therapy when thiazide diuretics are not tolerated. Alpha block- ers are not used as first-line therapy for hypertension because they are less effective for prevention of CVD than other first-step agents, such as thiazide diuretics.S8.1.6-3,S8.1.6-10 Recommendation-Specific Supportive Text 1. The overall goal of treatment should be reduction in BP, in the context of underlying CVD risk. 