What should be done if a patient has stage II hypertension?

• A. Individualized risk assessment & treatment plan
• B. Immediate aggressive treatment without assessment
• C. Lifestyle changes only
• D. No treatment

Answer: (A)

Stage II hypertension demands a risk-guided, personalized plan rather than a one-size-fits-all approach. Because blood pressure is elevated enough to push cardiovascular risk higher, the best course is to assess the patient’s overall risk profile—factors like age, diabetes, kidney disease, smoking, and prior cardiovascular events—and then tailor treatment to that profile. In practice, this usually means starting pharmacotherapy (often a two-drug combination from different classes) while also implementing lifestyle changes (weight management, diet, exercise, sodium reduction, limiting alcohol, smoking cessation). The goal is to lower BP to a range appropriate for the individual while reducing overall cardiovascular risk, with ongoing monitoring and adjustment as needed.

Immediate aggressive treatment without assessment isn’t appropriate because you need to know which medications are suitable and what risks exist for that person. Relying on lifestyle changes alone is typically insufficient for stage II hypertension, and doing nothing isn’t acceptable given the elevated risk.