Blood pressure elevated

Elevated 120-129/<80

Lifestyle Modifications, Goal <130/80

Class 1 130-139 / 80-89

ASCVD <10%

Lifestyle Mods

ASCVD > 10%

Black

CCB OR TZD

Non-Black

ACE/ARB OR TZD OR CCB (combine if necessary)

Aldosterone Antagonist and/or Beta Blocker

Class 2 >140 / >90

Class 2 >150 / >90

Black

CCB + TZD

Non-Black

ACE/ARB + CCB

ISH >140 / <90

TZD or CCB

Secondary Stroke Prevention

BP > 140/90

TZD OR ACE+TZD

BP < 140/90

Lifestyle Mods

HFpEF

Stage A - ACE/ARB

Stage B/C - ACE/ARB + BB

Hospitalized in <12 months

Aldosterone Antagonist + SGLT 2

Fluid overload

Loop Diuretics

HFrEF

ACE/ARB/ARNI + BB

Class II-IV

Aldosterone Antagonist + SGLT 2

Class III-IV, Black or ACE/ARB intolerant

Hydralazine + Isosorbide Dinitrate

Class II-IV, sinus rhythm, still symptomatic

Ivabradine

Class II-IV, A fib or still symptomatic

Digoxin

Class I-IV, Fluid Overload

Loop Diuretic

SIHD

ACE/ARB + BB

Chest pain

CCB

HTN still not resolved

Add CCB, TZD or MRA

DM

Albuminuria

ACE/ARB + (CCB and/or TZD)

No Albuminuria

Black

CCB or TZD

Non-black

ACE/ARB or TZD or CCB

CKD

Stage 1 or 2

Albuminuria

No albuminuria

ACE/ARB or TZD or CCB

Stage 3 or 4

Pregnancy

>20 weeks, >140/90

ER referral

Pre-existing

Methyldopa, Labetal, consider Nipedipine ER last

TZD before pregnancy

may continue