Available at: https://www.healthquality.va.gov/guidelines/CD/obesity/ Sidebar 5: Initiate Drug Therapy General Population: Recommend one or more of the following: Thiazide-type diuretics ACEIs or ARBs* Long-acting CCBs For patients unlikely to achieve goal with monotherapy (e.g., patients with SBP/DBP of >20/10 mm Hg above goal), consider initiating treatment with combination therapy or monotherapy with close follow-up for titration and/or addition of medications based on blood pressure response Specific Populations: For patients age 65 and over, we suggest a thiazide-type diuretic for reduction in composite cardiovascular outcomes For African American patients, we recommend against using ACEIs or ARBs as monotherapy For patients with CKD, see the VA/DoD CKD CPG9 *We recommend against more than one of the following three drug classes together in the same patient: ACEIs, ARBs, or direct renin inhibitors Abbreviations: ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium channel blocker; CKD: chronic kidney disease; CPG: clinical practice guideline Sidebar 6: Optimize Treatment Assess adherence Consider evaluating for interfering substances (some prescription medications, NSAIDs, alcohol, recreational drugs) Consider evaluating and addressing contributing lifestyle factors Optimize treatment (refer to Appendix F, Table F-1) Titrate initial drug Add another agent from a different class Reevaluate diagnosis (resistant HTN, secondary causes of HTN) Consider specialty consultation for patients with resistant HTN Consider co-interventions to enhance management of HTN and improve blood pressure: Pharmacist-led Nurse-led Dietitian-led Abbreviations: HTN: hypertension; NSAIDs: nonsteroidal anti-inflammatory drugs 9 See the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease. Available at: https://www.healthquality.va.gov/guidelines/CD/CKD/ VII. Recommendations Topic Sub- topic # Recommendation Strengtha Categoryb Screening, Diagnosis, and Monitoring a. Screening 1. We recommend screening adults for elevated blood pressure periodically. Strong for Not Reviewed, Amended b. Measurement Techniques 2. 