First-line management of essential hypertension typically includes which of the following?

• A. Lifestyle and Dietary Changes
• B. Pharmacotherapy With a Diuretic
• C. Immediate ACE Inhibitor Therapy
• D. Surgical Intervention

Answer: (A)

Starting with nonpharmacologic approaches is the best first step because essential hypertension often improves with changes that address modifiable factors, lowering blood pressure without medications. Focus on weight management, regular aerobic exercise, and a DASH-style diet rich in fruits and vegetables. Reducing sodium intake, limiting alcohol, and stopping smoking further help reduce vascular resistance and cardiovascular risk. These lifestyle measures can significantly lower blood pressure and set the stage for whether medications are needed later.

Medications such as a diuretic are typically added if blood pressure remains above goal after these changes or if the patient has higher overall cardiovascular risk. Immediate ACE inhibitor therapy isn’t universally started for all patients with essential hypertension, as its use depends on comorbid conditions or failure to reach targets with lifestyle changes. Surgical intervention has no role in first-line management of essential hypertension.