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Old 11-11-2012
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Sphygmomanometer stage 2 HTN at outset...

first visit of patient + stage 2 HTN [ confirmed after repeating after 20 min ]

i think in this case we would say to give 2 meds with lifestyle modification all at once and not just life style mod as in stage 1 HTN.

thoughts ?
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Old 11-12-2012
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Yes that is correct.

Most patients require 2 or more antihypertensive drugs to achieve the BP goal; when the BP is more than 20/10mm Hg above the goal, consideration should be given to initiating therapy with 2 drugs
The majority of people require more than one drug to control their hypertension. JNC7[1] and ESH-ESC guidelines[49] advocate starting treatment with two drugs when blood pressure is >20 mmHg above systolic or >10 mmHg above diastolic targets. Preferred combinations are renin–angiotensin system inhibitors and calcium channel blockers, or renin–angiotensin system inhibitors and diuretics.[71] Acceptable combinations include calcium channel blockers and diuretics, beta-blockers and diuretics, dihydropyridine calcium channel blockers and beta-blockers, or dihydropyridine calcium channel blockers with either verapamil or diltiazem. Unacceptable combinations are non-dihydropyridine calcium blockers (such as verapamil or diltiazem) and beta-blockers, dual renin–angiotensin system blockade (e.g. angiotensin converting enzyme inhibitor + angiotensin receptor blocker), renin–angiotensin system blockers and beta-blockers, beta-blockers and centrally acting agents.[71
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