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March 24, 2024

A 59-year-old man with a known history of hypertension presents to you for evaluation because he says

A 59-year-old man with a known history of hypertension presents to you for evaluation because he says he has had frontal headaches and blurred vision during the past few days. When asked, he does not note any focal weakness, numbness, chest pain, shortness of breath, palpitations, or recent illicit drug use. He tells you that he has been compliant with the antihypertensive medications that he takes at home (hydrochlorothiazide, lisinopril, and metoprolol), and he adds that he took these medications today. His blood pressure today is 200/130 mm Hg and his pulse is 90 beats/minute. General physical examination is unremarkable and neurologic examination is non-focal. Funduscopic examination shows flame-shaped hemorrhages and cotton wool spots. What would be an appropriate next step in the management of this patient’s blood pressure?

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