The 2001 Canadian hypertension recommendations: take-home messages

Mrs. J, a 72-year-old woman whom you are treating for continuing hip pain related to arthritis (diclofenac 75 mg/d), has been relatively healthy, but her blood pressure has been increasing recently. Over the last 3 visits it has been 184/92 mm Hg on average. Mrs. J is physically active and uninterested in dietary advice. She is a nonsmoker who does not drink alcohol. Her body mass index is 26 kg/m(2), and physical examination reveals a pulsatile mass in the upper abdomen. The rest of the examination is unremarkable. Electrolyte and creatinine levels, complete blood count, and urinalysis and electrocardiography results are all within normal ranges. The fasting glucose level is 5.6 mmol/L, total cholesterol 5.4 mmol/L, high-density lipoprotein cholesterol 1.1 mmol/L and triglycerides 1.3 mmol/L. Ultrasonography of the abdomen shows a tortuous aorta with no aneurysm. What drugs are recommended as starting therapy? Once this therapy has been started, what will you add as a second drug? As a third drug? Does the most recent evidence concerning treatment of hypertension, reflected in the 2001 revisions of the Canadian recommendations for the management of hypertension, mandate any changes from previous practice in the approach to therapy?