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Counseling on healthy diet and exercise
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This patient with 2 consecutive blood pressure measurements greater than 130/90 mmHg has stage 1 hypertension. Given this patient's age and lack of other cardiovascular risk factors, the first step in management should be counseling on healthy diet and exercise.The most common cause of hypertension in adults is essential hypertension that is attributed to age-related changes in the cardiovascular system which makes vessels less compliant. Secondary causes of hypertension include cardiovascular malformations (such as aortic coarctation), renovascular causes (renal disease, renal artery stenosis), endocrine abnormalities (Cushing disease, hyperthyroidism), and drug-induced (glucocorticoids, over the counter cold medications such as phenylephrine). The majority of patients with hypertension have essential hypertension. For those with few cardiovascular risk factors and low predicted risk, management begins with lifestyle changes including weight loss, exercise, and diet.Armstrong et al. comment on the JNC8 guidelines for managing essential hypertension. They state that patients under the age of 60 years and over 60 years should be treated to goals of blood pressures of 140/90 mmHg and 150/90 mmHg, respectively. They also state that if the patients have chronic kidney disease or diabetes, they should be treated to a goal of 140/90 mmHg irrespective of age.Incorrect Answers:Answer 2: Hydrochlorothiazide is a thiazide diuretic often used as a first line medication for the treatment of essential hypertension. This patient should receive counseling on healthy diet and exercise first.Answer 3: Lisinopril is an angiotensin converting enzyme inhibitor often used as a first line medication for the treatment of essential hypertension and it is protective against diabetic nephropathy.Answer 4: Losartan is an angiotensin receptor blocker often used as a first line medication for the treatment of essential hypertension with utility in preventing diabetic nephropathy in patients who cannot tolerate ACE inhibitors.Answer 5: Metoprolol is a beta blocker sometimes used for the treatment of essential hypertension. It reduced myocardial demand and can be used for coronary artery disease.Bullet Summary: Patients with stage 1 hypertension and no significant cardiovascular risk factors should first receive counseling on healthy diet and exercise.
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