Question 1 of 174

A 58-year-old man presents for follow-up of elevated blood pressure. He has no history of diabetes, chronic kidney disease, or cardiovascular disease and takes no medications. Properly measured, averaged office readings on three separate visits are 154/96 mm Hg, 150/94 mm Hg, and 152/98 mm Hg, confirmed by home readings averaging 150/95 mm Hg. His BMI is 29 kg/m2. Basic metabolic panel, urinalysis, and ECG are unremarkable. He has already reduced sodium intake and increased physical activity over the past 3 months. What is the most appropriate next step in management?

• A.Continue lifestyle modification alone and recheck in 3 months
• B.Initiate a single antihypertensive agent (chlorthalidone)
• C.Initiate two antihypertensive agents from different classes (e.g., an ACE inhibitor plus a dihydropyridine calcium channel blocker)
• D.Initiate atenolol as first-line monotherapy
• E.Obtain 24-hour ambulatory monitoring before starting any drug therapy