A patient presenting with blood pressure of 154/94 mm Hg and a high 10-year ASCVD risk should first receive what kind of intervention?

For a patient presenting with elevated blood pressure of 154/94 mm Hg and a high 10-year ASCVD risk, the most appropriate initial intervention is to consider immediate initiation of two antihypertensive medications. This approach aligns with current guidelines for managing hypertension in patients who are at high risk for cardiovascular events.

The rationale behind this recommendation is based on the concept of achieving better blood pressure control more rapidly, which is particularly crucial for individuals with a high risk of atherosclerotic cardiovascular disease (ASCVD). Dual therapy can lead to a more significant and quicker reduction in blood pressure, which is essential for mitigating the risks of potential cardiovascular events such as heart attack or stroke.

Initiating two medications can also enhance the likelihood of achieving target blood pressure goals, especially in patients who may be resistant to monotherapy alone due to various factors such as age, comorbidities, or medication adherence issues. The choice of medications for dual therapy often includes a combination of different classes, such as a calcium channel blocker and an ACE inhibitor or angiotensin receptor blocker, to provide complementary mechanisms of action.

In contrast, starting with only lifestyle modifications would not provide adequate or timely management given the patient's significantly elevated blood pressure and high ASCVD risk. Similarly