Antihypertensive drug classes are usually classified as 1st, 2nd, 3rd, and 4th or 5th choice to help physicians select the drug most suitable for treatment initiation among the very many classes available to lower blood pressure (BP) in patients with a BP elevation. However, this approach was appropriate decades ago when several drugs had inconveniences that made their use in monotherapy inadvisable. An example was the then widely used vasodilator hydralazine whose sodium-retaining and tachycardic effects made its administration recommendable only with a diuretic or a β-blocker, with, thus, a classification as a 2nd- or 3rd-choice drug (1). This is no longer the case because several current antihypertensive drug classes are characterized by a similar BP-lowering effect (2), a good tolerability profile (2), and evidence of cardiovascular protection in prospective randomized trials (3,4). As recently argued in a document of the European Society of Hypertension (5), this implies that rather than classifying drugs as 1st, 2nd, 3rd, and further choice, it might be more appropriate to help physicians select the drug (or drug combination) that might be preferred for treatment initiation in a given patient or a given clinical condition. This article will discuss the factors that may help physicians move toward this more individualized treatment approach. ### Demographic factors Evidence is available that antihypertensive treatment is protective in either hypertensive males or hypertensive females and that for a similar decrease in BP the reduction of cardiovascular risk is proportionally similar in both sexes (6). Thus, sex does not represent a factor to consider in the choice of antihypertensive treatment except for the need to avoid blockers of the renin-angiotensin system (ACE inhibitors, angiotensin receptor antagonists, and renin inhibitors) in pregnant women because of the suspicion, from animal studies, of teratogenic effects (7). Although the British guidelines have long maintained …