In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age. Initial antihypertensive treatment should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB in the general nonblack population or a thiazide diuretic or calcium channel blocker in the general black population. If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased, or a second medication should be added. From the AFP Editors Downloaded from the American Family Physician website at www.aafp.org/afp. Copyright 2014 American Academy of Family Physicians. For the private, noncom- mercial use of one individual user of the website. All other rights reserved. Contact copyrights@aafp.org for copyright questions and/or permission requests. Practice Guidelines 504 American Family Physician www.aafp.org/afp Volume 90, Number 7 second medication should be added (thia- zide diuretic, calcium channel blocker, ACE inhibitor, or ARB; do not combine an ACE inhibitor with an ARB). Blood pressure should be monitored and the treatment regi- men adjusted until the target blood pressure is reached. A third drug should be added if necessary; however, if the target blood pres- sure cannot be achieved using only the drug classes listed above, antihypertensive drugs from other classes can be used (e.g., beta blockers, aldosterone antagonists). Refer- ral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies. Adults with CKD and hypertension should receive an ACE inhibitor or ARB as initial or add-on therapy, based on moder- ate evidence that these medications improve kidney-related outcomes in these patients. Guideline source: Eighth Joint National Committee Evidence rating system used? Yes Literature search described? 