The American Heart Association, the European Society of Hypertension and European Heart Association, and various Meta-analyses agree that the magnitude of blood pressure reduction needed is the main determinant of cardiovascular risk reduction in both younger and older hypertensive patients, not a specific antihypertensive drug. The ACCOMPLISH clinical trial found that amlodipine + belapril (lortin) reduced cardiovascular risk by about 20% compared with hydrochlorothiazide + belapril, although blood pressure may be slightly higher in the amlodipine group. Some patients with hypertension also have other underlying abnormalities, and specific blood pressure lowering drugs may be able to lower blood pressure while improving a condition, such as diltiazem, verapamil, or beta-blockers for heart rate control in patients with atrial fibrillation. The following recommendations are also not appropriate for this particular patient. Single-drug therapy (when above the target blood pressure of 20/10 mmHg) Patients with hypertension may be treated with a single drug as initial therapy when the blood pressure is only 20/10 mmHg above the target blood pressure. Such drugs are: 1) low-dose thiazide diuretics 2) long-acting angiotensin-converting enzyme inhibitors (ACEI, Prilosec) or 3) angiotensin II receptor blockers (ARB sartans) or 4) long-acting diapyridyl calcium channel blockers (Dipyridamole). Considering that ACEI or ARB + dihydropyridine calcium channel blockers are often preferentially selected as combination therapy, we recommend that one of these drugs be preferred as initial monotherapy, thus facilitating easy combination therapy later if needed. In general, ACEI or ARB are more effective in younger patients, while dihydropyridine calcium channel blockers are more effective in the elderly and blacks. Second, if a thiazide diuretic is chosen, we recommend chlorothiazide rather than hydrochlorothiazide. Most American physicians, have little experience with chlorothiazide. For monitoring of hypokalemia, chlorothiazide and hydrochlorothiazide follow the same principles. Usually within three weeks, if there is no hypokalemia, the body has adapted to this diuretic. Third, we recommend that those patients who have little or no response to initial therapy be given a sequential monotherapy regimen. Combination therapy 1. For those patients whose initial blood pressure is 20/10 mmHg above the target blood pressure, we recommend giving a combination regimen. For example, long-acting ACEI or ARB + long-acting dihydropyridine CCB (belapril + amlodipine was used in the ACCOMPLISH trial) 2. For non-obese patients who have already achieved target blood pressure with ACEI or ARB + thiazide diuretics, we recommend discontinuing thiazide diuretics and switching to long-acting dihydropyridine CCB. For obese patients, the The combination of ACEI or ARB + thiazide diuretics needs to be continued. We recommend that for those patients whose blood pressure is well controlled with ACEI or ARB + thiazide diuretics, there is no need to change treatment. 3. For patients who have used a thiazide diuretic as monotherapy and have not achieved their target blood pressure, we recommend discontinuing the thiazide diuretic and replacing it with a long-acting ACEI or ARB + long-acting dihydropyridine CCB (Grade 2B). 4. For patients requiring antihypertensive therapy, we recommend that at least one medication be taken at bedtime, rather than all medications being taken early in the morning. Typically, nighttime blood pressure is an average of 15% lower than daytime blood pressure, and if the reduction in blood pressure during sleep is less than 10%, then this would be a risk factor for adverse cardiovascular events. Changing at least one drug to bedtime not only reestablishes normal blood pressure after sleep, but also reduces mean arterial pressure over 24 hours. In the HOPE and EUROPA clinical trials, ACEI taken at bedtime significantly reduced the incidence of cardiovascular events compared to placebo.