Referral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies. A third drug should be added if necessary however, if the target blood pressure cannot be achieved using only the drug classes listed above, antihypertensive drugs from other classes can be used (e.g., beta blockers, aldosterone antagonists). Blood pressure should be monitored and the treatment regimen adjusted until the target blood pressure is reached. If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased or a second medication should be added (thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB do not combine an ACE inhibitor with an ARB). In the general black population, including those with diabetes, initial treatment should include a thiazide diuretic or calcium channel blocker. In the general nonblack population, including those with diabetes, initial anti-hypertensive treatment should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB).
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