YES…definitely.  We need to recognize that although he is experiencing stress from work, that in general, his lifestyle is clearly impacting his health.  He is at high risk for a myocardial infarction or stroke if his blood pressure is not significantly reduced.  Lifestyle changes such as exercise and nutritional changes are important.  I would suggest making the priority diagnosis Altered Health Maintenance related to work stress, sedentary lifestyle, and poor nutritional intake as manifested by weight of 292 lbs, hypertension, reports of stress, lack of regular exercise.