1. In persons>50 years: systolic BP>140 is a much more important cardiovascular risk factor than diastolic BP.
2. The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg. Individuals who are normotensive at 55 years of age, have a 90% lifetime risk of developing hypertension.
3. Individuals with a systolic BP of 120-139 mm Hg or a diastolic BP of 80-89 mm Hg should be considered as prehypetensive and require-health promoting lifestyle modifications to prevent CVD.
4. Thiazide type diuretics should be used in most patients with uncomplicated hypertension either alone or combined with drugs from other classes.
5. Most patients with hypertension will require two or more medications to achieve goal BP (140/90 or <130/80 for patients with diabetes or chronic kidney disease).
6. If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with two agents, 1 of which usually should be a thiazide-type diuretic.

Compelling Indications

Ischemic heart disease
Angina pectoris: B-blockers; alternatively- long acting CCBs.
Acute coronary symptoms (unstable angina, myocardial infarction): initial treatment with B-blockers and ACE-inhibitors
Post myocardial infarction: B-blockers and ACE-inhibitors and aldosterone-antagonists have proven to be most beneficial.

Heart failure
Asymptomatic with ventricular dysfunction: ACE-inhibitors and B-blockers are recommended.
Symptomatic ventricular dysfunction or end stage heart disease: ACE-inhibitors, B-blockers ARBs and aldosterone-antagonists are recommended along with a loop diuretic.

Diabetic hypertension
Two or more drugs are usually needed to achieve target BP level of 130/80 mm Hg.
ACE-inhibitors and ARBS reduce progression of diabetic nephropathy and albuminuria and ARBS have been shown to reduce progression to macroalbuminuria.

Chronic kidney disease
ACE-inhibitors and ARBs reduce progression of diabetic and non-diabetic renal disease. A limited increase in serum creatinine, of as much as 35% above baseline, with ACE-inhibitors or ARBs is acceptable and not a reason to withhold treatment unless hyperkalemia develops.

Older individuals
Hypertension occurs in more than two thirds of individuals over the age of 65.
Recommendations are the same as for general care of hypertension. Lower initial doses may be indicated.