How Low Can You Go? Intensification of Antihypertensive Therapy in a 65-Year-Old Patient

A 65-year-old woman is referred to the cardiology clinic by her primary care provider for management of hypertension. She has a history of hyperlipidemia, hypertension, and asthma. Her medications include simvastatin 40 mg daily, valsartan 320 mg daily, chlorthalidone 25 mg daily, and an albuterol inhaler as needed. Her intake blood pressure (BP) is 167/82 mm Hg and on repeat check is 160/78 mm Hg. She tells you that she is taking her BP medications regularly and that her BPs are consistently higher in the office than at home. Her BP readings at home range from 140/70 to 150/80 mm Hg. You review the rest of her medical history and discover that she has never smoked, has no history of diabetes mellitus, and her recent lipid panel showed total cholesterol 200 mg/dL, high-density lipoprotein cholesterol 60 mg/dL, and low-density lipoprotein cholesterol 140 mg/dL.

Which one of the following is the best strategy to manage her BP?

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