Q. An 82-year-old woman presents to the clinic for a routine follow-up. She has been in generally good health but recently started monitoring her blood pressure at home due to occasional headaches. Over the past month, she has noted an average of three blood pressure readings per week, consistently around 155/80 mm Hg. She denies chest pain, shortness of breath, or any other symptoms. She has no history of diabetes, kidney disease, or cardiovascular events.
On physical examination, her pulse is regular at 78 beats per minute, and her blood pressure in the clinic is confirmed to be 158/82 mm Hg.
Laboratory investigations show that Serum sodium is 142 mEq/L, potassium is 4.5 mEq/L, creatinine is 1.0 mg/dL, and fasting blood glucose is 98 mg/dL. An electrocardiogram (ECG) shows normal sinus rhythm with no signs of hypertrophy or ischemia. She has no known drug allergies and is currently not on any medication.
What would be the most appropriate initial antihypertensive medication for her?