Many times the most important step that can be taken to reduce morbidity and mortality from common medical conditions such as diabetes and cardiovascular disease is to focus on lifestyle and/or risk factor modification. A 45-year-old, healthy nonsmoking woman with a normal BMI (24) has been found on two occasions to have a blood pressure of 145/95. She has no family history of premature coronary artery disease. For this patient, choose the most important step to take next.

The first patient can now be diagnosed with hypertension. Given the fact that she is still stage 1, lifestyle modification can safely be attempted before beginning a medication. She should be instructed in a 2.4-g sodium diet, daily aerobic exercise, and a restriction in alcohol intake to no more than one serving per day. If the patient does not respond to lifestyle interventions, then starting with monotherapy such as chlorthalidone at low dose would be a good option. Chlorthalidone is a thiazide diuretic that has a longer half-life (24-72 hours vs 7-12 hours for HCTZ).