 Randomized controlled trials  Adults ≥ 18 years old with hypertension  N >100  Duration: ≥ 1 year  Outcomes  Mortality, CVD related-mortality, CKD-related mortality  MI, HF, hospitalization-HF  Coronary or other revascularization  ESRD ▪ KF resulting in dialysis or transplantation, doubling of Cr value, halving of GFR

 In adults with HTN,  Does initiating antihypertensive drug therapy at specific BP thresholds improve health outcomes?  Does treatment with antihypertensive drug therapy to a specified goal lead to improvement in health outcomes?  Do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes?

45 y.o. white female Hx: HTN, hyperlipidemia, MDD Meds: Atorvastatin 20mg QD, Fluoxetine 20mg QD BP: 150/96, HR: 73 Treatment: 1. Lisinopril 10mg QD 2. Amlodipine 5mg 3. HCTZ mg QD 4. Metoprolol BID 10

64 y.o. white male Hx: CKD, HTN, hyperlipidemia Meds: simvastatin 20mg QD, ASA 81mg QD, lisinopril 20mg QD Labs: Cr = 1.9, K+ = 4.8, Est Clcr = 38 ml/min BP: 152/94, HR: 68 Treatment: 1. HCTZ mg QD 2. Amlodipine 5mg QD 3. Losartan 50mg QD 4. Increase lisinopril to 40mg QD 10

56 y.o. black male Hx: diabetes, HTN, obstructive sleep apnea Meds: metformin 1000mg BID, ASA 81mg QD, Gluctotrol XL 10mg QD Labs: Cr = 1.0 BP: 148/88, HR: 70 Treatment: 1. lisinopril 10mg QD 2. losartan 50mg QD 3. HCTZ mg QD 4. Furosemide 20mg QD 10

67 y.o. white male Hx: HTN, DM, hyperlipidemia, GERD, BPH Meds: finasteride 5mg QD, Zocor 80mg QD, terazosin 10mg QD, glimepride 4mg QD, Actos 45mg QD, lisinopril 10mg QD, metformin XR 2000mg/d, ASA 81mg QD Labs: Cr: 1.2, microalbumin 10mg/L, K+ = 4.3 BP: 160/88,HR: 57 Treatment 1. HCTZ mg QD 2. Hydralazine 25mg BID 3. Diltiazem XR 180mg QD 4. Increase lisinopril to 20mg QD 10

77 y.o. female Hx: HTN, osteoporosis, angina, GERD Meds: Reclast 5mg Qyear, Prilosec 40mg QD, Toprol XL 100mg QD, ASA, lisinopril/HCTZ 20/25mg QD BP: 169/66, HR: 57, weight: 100 lbs, Cr = 0.3, K+ = 4.2 Treatment: 1. Terazosin 2. Amlodipine 3. Hydralazine 4. Furosemide 10

78 y.o. female Hx: Afib (c/o palpitations), HTN Meds: warfarin, metoprolol 100mg BID, losartan 50mg QD BP: 154/82 HR: 90 Treatment 1. Amlodipine 2. Diltiazem XR 3. Spironolactone 4. Furosemide 10

66 y.o. black male Hx: HTN, s/p MI 2 months ago, hyperlipidemia Meds: atorvastatin 20mg QD, ASA 81mg QD, Plavix 75mg QD, HCTZ 25mg QD, metoprolol 100mg BID BP: 152/92, HR: 62 Treatment 1. Amlodipine 2. Lisinopril 3. Diltiazem XR 4. Furosemide 10

66 y.o. male Hx: CKD, HTN, diabetes, PAD, hypothyroidism, hyperlipidemia Meds: ASA 81mg QD, Lantus + Humalog, levothyroxine 0.1mg QD, Crestor 20mg QD, lisinopril 20mg QD Labs: Cr = 2.8, K+ = 4.8 BP: 150/92, HR: 68 Treatment 1. atenolol 2. amlodipine 3. HCTZ 4. hydralazine 10

70 y.o. male Hx: HTN, LVH, GERD, TIA Meds: Plavix 75mg QD, famotidine 20mg QD, HCTZ 25mg QD BP: 154/86, HR: 70 Treatment 1. Metoprolol 2. Lisinopril 3. Amlodipine 4. Spironolactone 10

62 y.o. female Hx: COPD, HTN, OA, obesity, CAD, occ symptomatic angina Meds: Spiriva, Advair, ASA, Imdur 90mg QD, lisinopril 40mg QD, metoprolol XL 100mg QD, Nitrostat PRN BP: 152/90, HR: 64 Treatment 1. HCTZ 2. valsartan 3. amlodipine 4. terazosin 10

 Age ≥ 60: goal BP is <150/90  Age <60: goal BP is <140/90  First line therapies  Thiazide, CCB’s, ACEI, ARB  Thiazide or CCB recommended over ACEI in blacks with diabetes  Beta-blockers: not recommended as first line therapy