Sandbox gc2

Adult aged ≥18 years with hypertension

Implement lifestyle interventions (continue throughout management)

Set blood pressure goal Inititate BP lowering-medication

General population (no diabetes or CKD)

Diabetes or CKD present

Age ≥60 years

Age <60 years

All ages Diabetes present No CKD

All ages CKD present with or without diabetes

Blood pressure goal SBP <150 mm Hg DBP <90 mm Hg

Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg

Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg

Blood pressure goal SBP <140 mm Hg DBP <90 mm Hg

Nonblack

Black

All races

Initiate thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination

Initiate thiazide-type diuretic or CCB, alone or in combination

Initiate ACEI or ARB, alone or in combination with other drug class.

Select a drug treatment titration strategy A. Maximize 1st medication before adding 2nd OR B. Add 2nd medication before reaching maximum dose of 1st medication OR C. Start with 2 medication classes separately or as fixed-dose combination

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. For strategies A and B: Add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class not previously selected and avoid combined use of ACEI & ARB). For strategy C: Titrate doses of initial medications to maximum.

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. Add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class not previously selected and avoid combined use of ACEI & ARB).

At goal blood pressure?

Yes

No

Reinforce medication and lifestyle adherence. Add additional medication class (eg, β-blocker, aldosterone antagonist, or others) and/or refer to physician with expertise in HTN management.

No

At goal blood pressure?

Yes

Continue current treatment and monitoring.