Your 67-year-old patient has a BP of 168/92 and, on her second visit, a BP of 158/88. What is your initial treatment plan?

The initial treatment plan for a patient with elevated blood pressure, especially in an older adult, often emphasizes lifestyle changes before commencing pharmacological treatments. Teaching lifestyle modifications is critical as these interventions can significantly impact blood pressure management and overall cardiovascular health.

Lifestyle changes may include encouraging the patient to adopt a heart-healthy diet (such as the DASH diet), increasing physical activity, reducing sodium intake, managing stress, and avoiding tobacco and excessive alcohol consumption. These strategies are essential for managing the condition holistically and can lay a strong foundation for any future treatment plans.

While medications like ACE inhibitors or diuretics can be effective in treating hypertension, initiating treatment with medication right away may not always be necessary or appropriate, especially for a patient who may be well-controlled on lifestyle modifications alone. If lifestyle changes do not sufficiently lower the patient's blood pressure over time, then progressing to medication can be considered.

Scheduling a stress test is generally not indicated as an immediate follow-up to assess blood pressure and does not address the management of hypertension directly.

Focusing first on lifestyle modifications allows for a comprehensive approach to hypertension that not only addresses the immediate concern of blood pressure but also promotes long-term health benefits.