The thiazide diuretic hydrochlorothiazide is the most appropriate agent for treating hypertension in this 57-year-old patient who is black. He has stage 1 hypertension, defined as a systolic blood pressure of 140-159 mm Hg and/or a diastolic blood pressure of 90-99 mm Hg. Thiazide diuretics (such as hydrochlorothiazide) and calcium channel blockers (such as amlodipine or diltiazem) alone or in combination are effective hypertensive treatment options for black patients and are recommended by the eighth report of the Joint National Committee (JNC 8) as initial therapy in this patient group. However, this patient is already taking a moderate dose of a statin (simvastatin) that undergoes significant metabolism via the cytochrome P450 3A4 (CYP3A4) pathway; lovastatin and, to a lesser extent, amlodipine are also metabolized through this pathway. Several calcium channel blockers inhibit or are metabolized through the CYP3A4 pathway and can increase the risk of statin myopathy in patients taking one of these particular statins. The non-dihydropyridine agents verapamil and diltiazem and the dihydropyridine agent amlodipine have been associated with increased risk with concurrent therapy with these drugs. Thus, hydrochlorothiazide is the most appropriate choice for this patient. The JNC 8 recommends a blood pressure goal of <140/90 mm Hg for black patients (for age ≥60 years, the target is <150/90 mm Hg, regardless of race). Prior recommendations had suggested blood pressure goals of <135/85 mm Hg in black patients given the higher risk of stroke and kidney disease compared with white patients. However, the African American Study of Kidney Disease and Hypertension (AASK) trial (comprised of black patients with hypertension and chronic kidney disease) did not demonstrate any difference in more aggressive (achieved blood pressure of 128/78 mm Hg) or less aggressive (achieved blood pressure of 141/85 mm Hg) blood pressure goals in slowing the rate of glomerular filtration rate decline or other secondary end points. Given his age and race, this patient's blood pressure goal is <140/90 mm Hg, according to JNC 8.

In general, black persons have less blood pressure response to renin-angiotensin system agents than other agents, despite similar plasma renin activity. Therefore, the ACE inhibitor lisinopril is not indicated for this patient.