For a patient with hypertension and elevated ASCVD risk, what is the recommended next step in management?

The recommended next step in managing a patient with hypertension and elevated atherosclerotic cardiovascular disease (ASCVD) risk is to add chlorthalidone 12.5 mg/day. Chlorthalidone is a thiazide-like diuretic that has been shown to effectively lower blood pressure and provide cardiovascular protection, particularly in patients at higher risk for heart disease.

Thiazide diuretics, such as chlorthalidone, are a cornerstone in the treatment of hypertension and are particularly beneficial for patients who have concomitant conditions that elevate their risk for cardiovascular events. They work by reducing blood volume and promoting vasodilation. Additionally, there is substantial evidence from clinical trials indicating that chlorthalidone not only lowers blood pressure but also reduces the incidence of heart attacks and strokes in hypertensive patients.

In contrast, increasing the dose of lisinopril may help control blood pressure but does not directly enhance cardiovascular protection in the same way as adding chlorthalidone does. While ACE inhibitors like lisinopril are important for specific patient profiles, they might not always be the most effective first step for patients with elevated ASCVD risk as compared to diuretics.

Adding atenolol, a beta-blocker, is typically not