A patient with a blood pressure of 154/86 mm Hg should next be advised to:

In the case of a patient with a blood pressure reading of 154/86 mm Hg, advising a return in two weeks for a repeat blood pressure measurement is a prudent approach. This decision acknowledges that the patient is exhibiting mildly elevated blood pressure, which may not immediately necessitate pharmacological intervention.

This follow-up allows for confirmation of the elevated reading and provides an opportunity to ensure that it is not a result of transient factors, such as stress or recent physical activity. It also encourages ongoing monitoring of the patient's blood pressure, which is vital in managing potential hypertension.

This strategy aligns with current guidelines, which recommend that if a patient's blood pressure is elevated but not severely high (typically classified as stage 1 hypertension), lifestyle modifications and monitoring may be the first steps before initiating medication. Therefore, allowing time for additional assessment and potential lifestyle adaptations is a sensible choice for managing the patient's health.

In contrast, initiating therapy with an ACE inhibitor or calcium channel blocker without further assessment may be premature, especially since the patient can be monitored first. Not taking any action would overlook the need for follow-up in a case of elevated blood pressure, as ongoing vigilance is important for cardiovascular health.