Lifestyle modifications in the treatment of hypertension

A 42-year-old woman presents for routine health maintenance examination. She is unaware of any medical problems but states that she has checked her blood pressure several times at local health fairs and has been advised that she has borderline high blood pressure and should seek medical attention. She recalls blood pressures ranging from 135/80 to 142/90. She takes no medications. She thinks that her mother had hypertension. She drinks socially, generally one or two glasses of wine on the weekends. She does not follow a specific exercise routine but states that she moves all the time. Breakfast is usually a Pop Tart with two cups of coffee. Lunch is a meal from McDonald's with two more cups of coffee. She and her husband eat out frequently for dinner because of their hectic schedules. On physical exam she is an overweight woman with BP 138/87 (checked at rest with an appropriately sized cuff), pulse 90/min, respiratory rate 12/min, height 64 in., weight 150 pounds, and BMI 27. Her waist circumference is 35 in. The remainder of her examination is within normal limits. Her screening chemistries and urinalysis are normal.