Clinical Presentation

• A 68 year old very sedentary, moderately obese black male is visiting his family practice clinic at the urging of his daughter. It has been 10 years since his last visit when he was found to be hypertensive but was not prescribed medication. Past medical history is significant for diverticulitis, appendectomy 15 years ago, and arthritis. The patient has smoked for about thirty years and has chronic obstructive pulmonary disease (COPD). The patient's father died of a myocardial infarction at 65 and his mother had hypertension and diabetes.
• Physical examination reveals an overweight black male complaining of severe pain in his hands which he says is caused by arthritis. He is 5' 8" and weights 92 kg. Blood pressure is 165/100 while sitting and 170/103 while standing. His pulse is 80/min and regular. Funduscopic exams shows mild arterial narrowing and sharp discs.
• Laboratory examination indicates blood urea nitrogen 55 mg/dL (reference range: 8 - 20 mg/dL);serum creatinine 2.1 ml/dL (reference range: 0.5-1.2 mg/dL); serum uric acid 7.2 mg/dL (reference range 4 - 8 mg/dL); total cholesterol 288 mg/dL (reference range: 150 -275 mg/dL); high density lipoprotein (HDL) 22 mg/dL (reference range: 30 -70 mg/dL).

An intern suggested that a low salt diet regimen for one month be tried before antihypertensive medication. Do you agree?