Briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.  What are the recommended medications to start this specific patient on? Provide the drug class, generic & trade name, and initial starting dose. 

Cardiovascular, Hematopoietic, Renal

Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. When she had her blood pressure taken at the health fair the reading was 168/99. She has gone back to the drug store 3 other times to take her blood pressure. The readings have been: 145/90, 150/89, 140/88. At the health fair she was told her BMI is elevated. Her cholesterol levels were also done at the health fair. The results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170.

She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this.

Today in the clinic her vital signs are: 

BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6

She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia.

Q1. Briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.

Q2. What are the recommended medications to start this specific patient on? Provide the drug class, generic & trade name, and initial starting dose.

Q3. Discuss the mechanism of action of each of the drugs you listed.

Q4. Discuss the side effect profile of each medication you listed.

Q5. Are there any interactions between any of the medications you prescribed?

Q6. What other non-pharmacological interventions would be suggested?