Many times the most important step that can be taken to reduce morbidity and mortality from common medical conditions such as diabetes and cardiovascular disease is to focus on lifestyle and/or risk factor modification. A 45-year-old, healthy nonsmoking woman with a normal BMI (24) has been found on two occasions to have a blood pressure of 145/95. She has no family history of premature coronary artery disease. For this patient, choose the most important step to take next.

**Core Concept**
Lifestyle and risk factor modification are crucial in managing common medical conditions such as hypertension, diabetes, and cardiovascular disease. Early intervention and prevention can significantly reduce morbidity and mortality.

**Why the Correct Answer is Right**
For this patient, the most important step would be to initiate lifestyle modifications, specifically dietary changes and increased physical activity, as she has no other risk factors for cardiovascular disease. This approach addresses the underlying pathophysiology of hypertension, which is often multifactorial and influenced by lifestyle factors. The patient's normal BMI and lack of family history of premature coronary artery disease further support this approach.

**Why Each Wrong Option is Incorrect**
**Option A:** Starting antihypertensive medication immediately would be premature, as the patient's blood pressure is not significantly elevated, and lifestyle modifications have not been attempted first.
**Option B:** Referral to a cardiologist would be unnecessary at this stage, as the patient's risk factors do not warrant immediate specialist referral.
**Option C:** Fasting lipid profile and glucose testing would be appropriate in the future, but not as the next step in management, as the patient's blood pressure is the primary concern.

**Clinical Pearl / High-Yield Fact**
It is essential to remember that lifestyle modifications are the cornerstone of managing hypertension and other common medical conditions. Early intervention with diet and exercise can significantly reduce the need for pharmacological therapy and improve patient outcomes.

**Correct Answer: D. Lifestyle modification, including dietary changes and increased physical activity, is the most appropriate next step for this patient.**

✓ Correct Answer: B. Recommend an exercise program such as brisk walking for at least 30 minutes per day and a low salt, Dietary Approaches to Stop Hypertension (DASH) diet.