Blood pressure elevated

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Blood pressure elevated

Compelling Indication

Pregnancy

Pre-existing

TZD before pregnancy

may continue

Methyldopa, Labetal, consider Nipedipine ER last

>20 weeks, >140/90

ER referral

CKD

Stage 3 or 4

Stage 1 or 2

No albuminuria

DM

No Albuminuria

Non-black

ACE/ARB or TZD or CCB

CCB or TZD

Albuminuria

ACE/ARB + (CCB and/or TZD)

SIHD

ACE/ARB + BB

HTN still not resolved

Add CCB, TZD or MRA

Chest pain

CCB

HFrEF

ACE/ARB/ARNI + BB

Class I-IV, Fluid Overload

Loop Diuretic

Class II-IV

Class II-IV, A fib or still symptomatic

Digoxin

Class II-IV, sinus rhythm, still symptomatic

Ivabradine

Class III-IV, Black or ACE/ARB intolerant

Hydralazine + Isosorbide Dinitrate

HFpEF

Stage B/C - ACE/ARB + BB

Fluid overload

Loop Diuretics

Hospitalized in <12 months

Aldosterone Antagonist + SGLT 2

Stage A - ACE/ARB

Secondary Stroke Prevention

BP < 140/90

BP > 140/90

TZD OR ACE+TZD

No Compelling Indication

ISH >140 / <90

TZD or CCB

Class 2 >150 / >90

ACE/ARB + CCB

CCB + TZD

Class 2 >140 / >90

Class 1 130-139 / 80-89

ASCVD > 10%

Non-Black

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

Aldosterone Antagonist and/or Beta Blocker

Black

CCB OR TZD

ASCVD <10%

Lifestyle Mods

Elevated 120-129/<80

Lifestyle Modifications, Goal <130/80