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Initial antihypertensive recommendations for patients under 60 with blood pressure over 20 mmHg higher than the norm should include thiazide diuretics, ACE inhibitors, ARBs, or CCBs, either alone or in combination (Flack & Adekola, 2020). Considering that we are unsure if the patient has any additional comorbidities besides obesity and smoking, it would be imperative to obtain lab work. Initial therapy for this patient could be dual therapy based on how elevated her reading is.  Based on the guidelines from AHA/ACC, I would prescribe Lisinopril/Hydrochlorothiazide 10/12.5, 1 tablet daily (Flack & Adekola, 2020).

A priority for this patient would be smoking cessation. Smoking cessation is associated with a decrease in systolic and diastolic pressure (Tsai et al., 2021). Smoking is a major modifiable risk factor that is associated with multiple cardiovascular and renal diseases and causes over seven million deaths annually (Tsai et al., 2021). Losing weight and engaging in physical exercise can also significantly improve blood pressure, with the recommendation of 90-150 minutes of aerobic exercise a week (Flack & Adekola, 2020).

Appropriate testing for this patient would include labwork, specifically CBC, CMP, lipid panel, TSH, and UA, to evaluate for secondary causes of hypertension. Additionally, an

EKG should be performed to monitor heart rate and rhythm and check for left ventricular hypertrophy. With this bloodwork, the patient’s ASCVD risk can be calculated, which looks at a 10-year risk of heart disease (Iqbal & Jamal, 2023). Additionally, I would review the patient’s medications to monitor for any that may be aiding in her elevated blood pressure; these can include steroids, NSAIDS, and oral birth control pills (Flack & Adekola, 2020).

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