From the Guidelines
The most appropriate next step is to recommend decreased alcohol intake. This patient has borderline elevated blood pressure readings (130/85 mmHg and 132/70 mmHg) and consumes 3 glasses of wine most evenings, which exceeds recommended limits 1. Alcohol consumption is a modifiable risk factor for hypertension, with intake above 1-2 drinks daily known to raise blood pressure. Reducing alcohol to no more than 1-2 drinks per day for men can help lower blood pressure by 2-4 mmHg. Some key points to consider in managing this patient's blood pressure include:
- Lifestyle modifications, such as reducing alcohol intake, are recommended as the first line of treatment for patients with borderline elevated blood pressure readings 1.
- The patient's excellent health habits, including regular exercise, a vegetarian diet, and a normal BMI, make lifestyle modifications a particularly appropriate approach.
- Before initiating medication or pursuing diagnostic testing for secondary causes of hypertension, lifestyle modifications should be attempted first, especially when blood pressure elevations are modest.
- The 2020 international society of hypertension global hypertension practice guidelines recommend moderation of alcohol consumption, with a daily limit of 2 standard drinks for men and 1.5 for women 1.
Given the patient's current alcohol consumption and borderline elevated blood pressure readings, recommending decreased alcohol intake is the most appropriate next step.
From the Research
Patient Assessment
The patient is a 45-year-old man with a history of high blood pressure readings at health fairs, but his past medical history and review of systems are unremarkable. He has a healthy lifestyle, being a vegetarian and exercising aerobically for 60 minutes daily.
Lifestyle Interventions
- The patient's current lifestyle is already aligned with some of the recommended interventions for preventing and treating hypertension, such as regular physical exercise 2, 3.
- However, his alcohol intake is worth noting, as moderation of alcohol consumption is recommended for patients with hypertension 4.
- There is no indication that the patient needs to change his diet, as he is already a vegetarian, but he may benefit from other lifestyle modifications such as stress management and adequate sleep patterns 3.
Next Steps
- Considering the patient's blood pressure readings and lifestyle, recommending decreased alcohol intake may be beneficial 4.
- Additionally, resistance training could be a useful addition to his exercise program, as it can help improve overall cardiovascular health 2, 5.
- There is no clear indication for ordering renal artery ultrasonography, thyroid-stimulating hormone and thyroxine levels, or prescribing a thiazide diuretic at this time, as the patient's blood pressure readings are not significantly elevated and his lifestyle is already relatively healthy.