MEDizzy - A 55-year-old man presents to establish primary care. His

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HYPERTENSION

A 55-year-old man presents to establish primary care. His medical history is significant only for 40 pack- years of smoking. He drinks four beers a night. He is minimally physically active. On physical examination, the patient’s blood pressure is 158/98 mm Hg, and he is moderately obese (body mass index, 27); the rest of his examination is normal. His laboratory examination, including a chem 7, CBC, TSH, and urinalysis, is normal, as is his electrocardiogram. Repeated blood pressure measurements over the next month are similar to the values first obtained. With respect to this patient’s blood pressure, what therapeutic option should be offered to this patient now?

ExplanationThe correct answer is C. This patient has stage 1 (systolic, 140 to 159 mm Hg; diastolic, 90 to 99 mm Hg), or mild, hypertension. Given his smoking history, he has greater than or equal to 1 risk factor for CV disease, which puts him in risk group 2. On the basis of the JNC VI (Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure) recommendations, it is appropriate to try lifestyle modifications (weight loss, dietary modification such as adherence to the DASH [Dietary Approaches to Stop Hypertension] diet, and moderate exercise) for 6 months before starting medications.