Mr. Fowler returns in one month as advised and reports that he smoked his last cigarette two weeks previously. He is using bupropion and is attending a smoking cessation group therapy session once a week. He is experiencing some irritability and difficulty sleeping, but feels that he is coping with this pretty well and is optimistic that he will be able to stay away from cigarettes. He indicates that his wife is supportive of this process.
He also reports that he is adhering to his diet. This is difficult for him, but he feels that he is doing pretty well with it and is encouraged by the fact that he has lost five pounds since he started on the diet.
He is also walking one mile in approximately 17-18 minutes five times a week. He has not experienced any chest pain, shortness of breath or other discomfort related to this. He also indicates that he is taking stairs instead of elevators at work and is intentionally parking one to two blocks away from his destination when he goes shopping.
He had his blood pressure checked approximately two weeks previously and again one week previously. His blood pressures were 150/90 mmHg and 145/92 mmHg on those occasions. He reports that his intake of alcohol has not changed. He also indicates that his libido and sexual functioning have improved and that he and his wife are "getting along better."
On examination, his weight is 189 pounds, and his blood pressure is 145/86 mmHg in his right arm, sitting and 148/85 mmHg in his left arm, sitting.
- What is the appropriate management of this patient at this time? Should he be started on an anti-hypertensive agent? Should his serum cholesterol and/or his serum lipid profile be repeated? Does he need any other screening or diagnostic tests performed?
- What is the appropriate follow-up of this patient?
- What is the "goal" for systolic and diastolic pressures?