Patents at low cardiovascular risk and stage 1 hypertension can be initially treated with lifestyle modification solely. Those with manifestations of target organ damage and sustained BP >140/90 should have initiation of pharmacologic therapy after diagnosis of hypertension is confirmed. All classes of blood pressure lowering drugs have similar effects in reducing coronary heart disease and stroke for a given level of BP reduction. The Canadian Hypertension Education Program outlines specific clinical scenarios when specific anti-hypertensive classes are preferred (at least as initial therapy). These compelling indications include such clinical entities as; previous stroke (preferred use of ACEi/ARB and thiazide diuretics), left ventricular systolic dysfunction (ACEi, ARB, B-blocker and spironolactone), and CKD with proteinuria (RAS blockade – ACEi or ARBs).