A 37-year-old woman comes to the physician for a follow-up blood pressure check. On previous visits over the last 12 months, the
patient's blood pressure readings ranged from 145/90-150/95 mm Hg She measured her blood pressure during a health fair 2 weeks
ago and it was 145/90 mm Hg The patient currently feels well, has no other medical problems, and has never been pregnant Her
current medications include a combination oral contraceptive for the past 5 years and occasional acetaminophen for relief of tension
headaches. She does not use tobacco, alcohol, or illicit drugs There is no family history of hypertension, stroke, deep venous
thrombosis, or heart attack. Her current blood pressure is 150/90 mm Hg, pulse is 80/min, and BMI is 22 kg/m2 The physical
examination shows no abnormalities. The electrocardiogram (ECG} is normal. Her total cholesterol level was 170 mg/dl 6 months
ago. Complete blood count, urinalysis, and basic metabolic panel are unremarkable. Which of the following is the most appropriate
next step in the management of this patient?
Q A Begin a diet and exercise regimen
Q B. Discontinue the oral contraceptive and switch to an alternate birth control method
Q C. Initiate a low-dose thiazide diuretic
Q D. Perform a CT angiogram of the abdomen
Q E. Reassure the patient as no intervention is required at this time
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