Although there is clinical trial evi- dence that both drug and nondrug therapy will interrupt the progressive course of hypertension,S8.1.5-6 there is no trial evidence that this treatment decreases CVD mor- bidity and mortality. The clinical trial evidence is stron- gest for a target BP of 140/90 mm Hg in this population. However, observational studies suggest that these indi- viduals often have a high lifetime risk and would benefit from BP control earlier in life.S8.1.5-19,S8.1.5-20 8.1.6. Choice of Initial Medication Recommendation for Choice of Initial Medication References that support the recommendation are summarized in Online Data Supplement 27 and Systematic Review Report. COR LOE Recommendation I ASR 1. For initiation of antihypertensive drug therapy, first-line agents include thiazide diuretics, CCBs, and ACE inhibitors or SR indicates systematic review. Synopsis The overwhelming majority of persons with BP sufficiently elevated to warrant pharmacological therapy may be best treated initially with 2 agents (see Section 8.1.6.1). 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. 