A 42-year-old man presents to the primary care clinic for a follow-up visit regarding elevated blood pressure. Over the past three months, his blood pressure measurements have consistently ranged from 145/92 mmHg to 152/96 mmHg despite strict lifestyle modifications. His past medical history is significant for asthma, which is well-controlled with an as-needed albuterol inhaler. The physician decides to initiate pharmacologic antihypertensive therapy. Which of the following medications should be avoided in this patient due to the risk of exacerbating his underlying respiratory condition?
- PropranololAnswer
- BLisinopril
- CAmlodipine
- DHydrochlorothiazide
- ELosartan
Answer
Propranolol should be avoided because it is a non-selective beta-blocker that can trigger bronchospasm in asthmatic patients.
The correct answer is the non-selective beta-blocker. Non-selective beta-blockers inhibit both beta-1 receptors (primarily in the heart) and beta-2 receptors (found in bronchial smooth muscle). Blockade of beta-2 receptors leads to bronchoconstriction and increased airway resistance, which can precipitate a severe or even fatal asthma exacerbation in susceptible individuals. Therefore, they are explicitly contraindicated in patients with a history of asthma.
Step-by-Step Solution
Key Concept
Non-selective beta-blockers are contraindicated in patients with asthma due to the risk of inducing bronchoconstriction via beta-2 receptor blockade.