In addition to lifestyle modifications, rechecking blood pressure in 1 year is appropriate for this patient with prehypertension. Although the eighth report of the Joint National Committee (JNC) did not address prehypertension, JNC 7 defined prehypertension as a systolic blood pressure of 120-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg in the absence of preexisting end-organ disease (for example, diabetes mellitus, chronic kidney disease, or cardiovascular disease). Lifestyle modifications, including a low salt diet and exercise regimen, can be used to effectively reduce blood pressure in patients with prehypertension. Patients with prehypertension may also adopt the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes vegetables, fruits, whole grains, legumes, and low-fat dairy products and limits sweets, red meat, and saturated/total fat, along with dedicated weight loss planning. Appropriate follow-up for those with prehypertension occurs at annual visits. The mean blood pressure in this patient (even accounting for the potential of inaccurate technique upon initial check-in) falls within the prehypertensive range, making lifestyle modifications and follow-up in 1 year the appropriate management. If blood pressures measuring 140/90 mm Hg or greater were documented, this would require repeat measurements for at least three visits over the period of at least 1 week of more to establish a diagnosis of hypertension.

Although there is an increased risk of stroke and cardiovascular disease for every level of blood pressure above 115/75 mm Hg and an increased risk of the development of hypertension, treatment of prehypertension using pharmacologic therapy (such as an ACE inhibitor or diuretic) has not yet been demonstrated to reduce this risk.

Ambulatory blood pressure monitoring records blood pressures periodically during normal activities. It is indicated primarily for diagnosis of suspected white coat hypertension (persistently elevated blood pressure readings in the office without evidence of end-organ damage) or to confirm a poor response to antihypertensive medication. It may also be useful in assessing for masked hypertension (evidence of end-organ damage without apparent elevated blood pressures) or for evaluating episodic or resistant hypertension. It is not indicated for this patient with evidence of prehypertension.