A 58-year-old woman with a history of a lacunar stroke 3 months ago presents for follow-up. After her stroke, she was started on amlodipine 5 mg daily for hypertension. Her blood pressure in the office today is 136/84 mmHg. She feels well.
Which of the following is the most appropriate next step in her management?
- Continue current management and recheck blood pressure in 3 months.
- Increase the amlodipine dose or add a second antihypertensive agent. (correct answer)
- Advise lifestyle modifications only as the primary intervention.
- Discontinue amlodipine and switch to hydrochlorothiazide.
Explanation: For secondary stroke prevention, current AHA/ASA guidelines recommend a target blood pressure of <130/80 mmHg. This patient's blood pressure is above this goal. Therefore, her antihypertensive regimen should be intensified. This can be achieved by increasing the dose of her current medication (amlodipine) or by adding a second agent, such as a thiazide diuretic or an ACE inhibitor/ARB.