Chart 9.4. – Pharmacological treatment: levels of evidence and level of recommendation.

Drug combinations	LE	LR
The preferential medication classes for antihypertensive treatment are thiazide or thiazide-like DIUs, CCBs, ACEIs, and ARBs, as they have been shown to effectively lower BP and the risk of CV outcomes. BBs should be considered for specific clinical scenarios (CAD, HF and HR control)	A	I
HT treatment may be initiated with two-drug class combinations starting in stage 1 HT	B	I
Two-drug treatments should begin with an ACEI or ARB combined with a thiazide or thiazide-like DIU or a CCB	A	I
HT treatment for high CV risk patients combining an ACEI and a dihydropyridine CCB is preferred over combining an ACEI and a thiazide DIU for nonobese patients	B	I
When two medications combined are unable to control BP, patients should be prescribed three drugs, usually an ACEI or ARB combined with a thiazide or thiazide-like DIU and a CCB	A	I
When three medications combined are unable to control BP, preference should be given to adding spironolactone to the therapy regimen	B	I
HT treatment with fixed combinations enables higher adherence rates	B	IIa
HT treatment combining two renin-angiotensin system antagonists is contraindicated	A	III