A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?
a. Notify the provider and discuss ordering a beta blocker for this patient.
b. Notify the provider and suggest a thiazide diuretic as initial therapy.
c. Order a diet low in sodium and high in potassium for this patient.
d. Recheck the patient's blood pressure in 4 hours to verify the result.
ANS: A
Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI; beta blockers are indicated for patients with pre-existing heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition.
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