Which intervention must the nurse prioritize for a hypertensive patient with coronary artery disease?

Coronary artery disease (CAD) with hypertension involves endothelial dysfunction, atherosclerotic plaque formation, and increased myocardial oxygen demand. Elevated blood pressure increases afterload, reduces coronary perfusion, and predisposes to myocardial ischemia, angina, and acute coronary syndrome. Rationale: A. Antihistamines have no therapeutic role in managing hypertension or coronary artery disease. They do not reduce vascular inflammation related to atherosclerosis. This intervention does not improve myocardial oxygen supply-demand balance or prevent ischemic events. B. Promoting stress reduction decreases sympathetic stimulation, lowering heart rate, blood pressure, and myocardial oxygen demand. Monitoring for chest pain allows early detection of ischemia. This directly addresses prevention of myocardial ischemia and cardiac complications. C. A low fiber diet is not indicated for coronary artery disease or hypertension management. In fact, fiber supports lipid regulation and cardiovascular health. This intervention does not improve vascular function or reduce cardiac workload. D. Instructing the patient to stop lower extremity exercises is inappropriate unless contraindications exist. Regular aerobic activity improves cardiovascular fitness and blood pressure control. This intervention may reduce beneficial effects on cardiac perfusion and vascular health.