How do you decide in older adults with newly diagnosed stage 2 hypertension when to start with two antihypertensive agents versus taking a more cautious approach due to concerns about potential orthostasis, frailty, or polypharmacy?

How do you decide in older adults with newly diagnosed stage 2 hypertension when to start with two antihypertensive agents versus taking a more cautious approach due to concerns about orthostasis, frailty, or polypharmacy?

• I prioritize starting with two antihypertensive agents, adhering to the guidelines straightforwardly
• I assess for signs of orthostasis, frailty, or significant polypharmacy first, and then decide whether to start with one or two agents based on these factors
• I typically start with one antihypertensive agent even in stage 2 hypertension, due to concerns about potential side effects, and add a second agent only if needed