Compelling indications
ASCVD ≥ ~7.5–10% / clinical ASCVD
HF with reduced EF
Post-myocardial infarction
Proteinuric CKD
Angina pectoris
Atrial fibrillation (rate control)
Atrial flutter (rate control)
Hypokalemia
Likely to have a favorable effect
Diabetes
Benign prostatic hyperplasia
Essential tremor
Hyperthyroidism
Migraine
Osteoporosis
Raynaud phenomenon
Edema / volume overload
Concerning comorbid conditions
Orthostatic hypotension
Frail (esp. ≥75y)
Depression (med-sensitive)
Gout
Hyperkalemia
Hyponatremia
Contraindications
Angioedema (ACEi)
Bronchospastic disease
Liver disease
May become pregnant
2nd/3rd-degree heart block
Pertinent positives
    BP Stage: Stage 2
    Suggested initial approach

    Notes
    • Prefer thiazide-like diuretics (chlorthalidone/indapamide) over hydrochlorothiazide when a diuretic is chosen.
    • Do not combine ACE inhibitor + ARB; avoid beta-blocker + verapamil/diltiazem at initiation.
    • Check BMP/creatinine and electrolytes 1–3 weeks after starting ACEi/ARB, diuretics, or MRAs; sooner if CKD.
    • Single-pill combinations improve adherence; consider cost/availability.
    • This tool is for initial management in adults and is not a substitute for clinical judgment.
    🏃 Lifestyle Modifications (All Patients)
    • Weight loss if overweight (target 1 kg reduction → ~1 mmHg BP reduction)
    • DASH diet (rich in fruits, vegetables, whole grains, low-fat dairy)
    • Reduce sodium intake (target <1500 mg/day, minimum 1000 mg reduction)
    • Increase potassium intake (3500-5000 mg/day from diet)
    • Physical activity: 90-150 min/week aerobic exercise
    • Limit alcohol (≤2 drinks/day for males, ≤1 drink/day for females)