LIFESTYLE MODIFICATIONS
Weight reduction
DASH/Mediterranean diet
Dietary sodium restriction
Exercise
Moderate ETOH
Cessation of smoking
K supplementation in diet (ADA, CHEP)

SPECIAL GROUPS
African-Americans without CKD: initiate with CCBs and thiazide
Patients with CKD regardless of race: initiate with ACEI or ARBs
DO NOT COMBINE ACEI with ARBs
In patients >75 y with CKD, use CCB and thiazide-type diuretic instead of ACEI/ARBs

End

PHARMACOTHERAPY
if BP 140/90 mmHg in the general population aged <60 y
if BP 150/90 mmHg in general population aged 60 y
if BP 140/90 mmHg in patients with DM, CKD, >60 y

First-line therapy
Start with one of:

Thiazide-type diuretics
Calcium channel blockers
ACE inhibitors
ARBs

Second/third-line alternatives
High doses or combination of:

Thiazide-type diuretics
Calcium channel blockers
ACE inhibitors
ARBs

Later-line alternatives

Beta-blockers
Alpha-blockers
Alpha1/Beta-blockers (carvedilol), vasodilating Beta-blockers (nebivolol)
Central Alpha2/-adrenergic agonists (clonidine)
Direct vasodilators ((hydralazine)
Loop diuretics (furosemide)
Aldosterone antagonists (spironolactone)
Peripherally acting adrenergic antagonists (reserpine)