HTN Intervention

A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of  breath, chest pain or visual changes.  He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.”  His physical examination shows no acute distress, grade 1 HTN retinopathy, and S4 heart sound, neck veins WNL, chest is clear, no peripheral edema with resting HR= 73, RR=16. 12-lead ECG is WNL. BMI= 33. Which of the following is the next best step in this patient’s care?

A.  Administer in-office oral clonidine and reassess blood pressure in 1 hour.
B.  Activate EMS with prompt transfer to emergency department
C.  Restart prior blood pressure medications with follow-up within the next month
D.  Advise restricting dietary sodium and weight loss to help with BP control.

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