1. Reiterate the importance of lifestyle modifications
	Implement a low-sodium DASH diet
	Lose weight if overweight
	Promote physical activity
	Limit alcohol intake
2. Make adherence to medication regimen as easy as possible
	Keep in mind cost to the patient
	Use once-daily regimens
	Use fixed-dose combination pills
3. Eliminate or minimize interfering substances, if possible (see Table 3)
4. Consider secondary causes:
	Chronic kidney disease
	Coarctation of the aorta
	Cushing syndrome
	Hyper- or hypothyroidism
	Hyperaldosteronism
	Hyperparathyroidism
	Obstructive sleep apnea
	Pheochromocytoma
	Renal artery stenosis
5. Intensify pharmacologic therapy (should already be on three agents at moderate doses, usually a diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a CCB or beta blocker); options at this point include:
	Increase dose of diuretic, or change to a loop diuretic for those with a glomerular filtration rate < 30 mL per minute per 1.73 m2
	Add an alpha blocker (e.g., terazosin [formerly Hytrin])
	Use a combined alpha-beta blocker (e.g., labetalol [Trandate], carvedilol [Coreg])
	Add spironolactone (Aldactone; starting at 12.5 mg daily), eplerenone (Inspra; starting at 25 mg daily), or amiloride (Midamor; starting at 2.5 mg daily)
	Add clonidine (Catapres), guanfacine (Tenex), reserpine, or hydralazine (Apresoline; requires multiple daily doses)
	Consider using both a nondihydropyridine and a dihydropyridine CCB
6. Consider referral to a hypertension specialist