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Initial Choice of Antihypertensive Medication

The initial choice of antihypertensive medication for J.S. would be a thiazide-type diuretic, such as hydrochlorothiazide. This recommendation is based on the 2017 American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, which recommends thiazide-type diuretics as first-line agents for the treatment of hypertension in non-African American patients, including Hispanics (Whelton et al., 2018). The guideline suggests that these medications are effective and well-tolerated in this population.

Priority Therapeutic Lifestyle Change

A priority therapeutic lifestyle change for J.S. would be tobacco cessation. The ACC/AHA guideline emphasizes that tobacco use is a major risk factor for cardiovascular disease and recommends that patients with hypertension be counseled to quit smoking (Whelton et al., 2018). Tobacco cessation programs and pharmacotherapies such as nicotine replacement and bupropion can be offered to support this lifestyle change.

Diagnostic Tests for Baseline Assessment

Several diagnostic tests would be ordered for J.S. to establish a baseline before starting antihypertensive therapy. These would include:

Electrolyte panel: To assess for hypokalemia, which can be induced by diuretics.
Blood urea nitrogen (BUN) and creatinine: To assess renal function, as some antihypertensives can exacerbate kidney disease.
Fasting glucose: To screen for diabetes, a common comorbidity with hypertension.
Lipid profile: To assess for dyslipidemia, another cardiovascular risk factor.
Electrocardiogram (ECG): To assess for left ventricular hypertrophy, a complication of long-standing hypertension.

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