Hypertension is a serious medical issue that can increase a person’s risk of developing other chronic diseases. This 46-year-old African American woman remains hypertensive despite metoprolol tartrate 25MG twice daily. African Americans respond differently to high blood pressure medication than other ethnic groups. Blacks physiologically have excessive levels of angiotensin which makes certain medications such as ace inhibitors, arbs, and beta-blockers less responsive. For African descent patients, initial treatment for hypertension without evidence of heart failure or chronic kidney disease should include CCB or a thiazide diuretic (Hassan & Zeltse, 2022). Due to her history of Myocardial Infarction, I would recommend discontinuation of Metoprolol and monotherapy with Hydrochlorothiazide 25 MG orally once daily. If the blood pressure persists increase Hydrochlorothiazide 50MG once daily or in two divided doses of 25MG. Non-pharmacological consists of the limitation of salt, saturated fats, and exercise.