What is the best anti-hypertension drug in this case and why?

September 21st, 2008 | by Pressurized |
THE BEST asked:


MR M.A is a healthy 36-year old obese male.his BP was found of 178/114 mmhg. He is a heavy smoker and drinks 10 or more units of alchohol each evening. He has a sedentary occupation.
what anti hypertension agent coud be used in initial management of his hypertension?

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  1. 7 Responses to “What is the best anti-hypertension drug in this case and why?”

  2. By jillian i on Sep 24, 2008 | Reply

    9 times out of ten Dr.s will start a patient out on a beta blocker.

  3. By mina x on Sep 24, 2008 | Reply

    benicar hct
    metoprolol
    clonidine
    amlodipine-benazepril
    and then encourage him to seriously stop smoking and reduce his alcohol intake. cause you are looking at stroke or heart attack in your future.

  4. By inflammatory_exudate on Sep 27, 2008 | Reply

    heavy smoker = COPD (i am afraid he may b suffering from asthma-like attacks & should b kept away from beta blocker!!!)
    i would suggest Ca channel blockers

  5. By nicedoc on Sep 29, 2008 | Reply

    He needs a more thorough evaluation for his hypertension to rule out secondary causes like renal artery stenosis or pheochromocytoma because of his young age despite his numerous risk factors. Otherwise, I agree that a calcium channel blocker is probably the best choice for him.

  6. By W W D on Sep 30, 2008 | Reply

    You can expect he’s a bit fluid-overloaded and has high sympathetic tone. Either clonidine or a diuretic would be a decent choice to start, if indeed he needs drug treatment. If you try ACE inhibitors or calcium-channel blockers, he’s going to swell up like a toad. Beta blockers may do the same, and he may wheeze or discontinue because of ED.
    It’s far from certain, though, that he’s hypertensive at all, or that it needs medication for control, despite his being at the normal age for essential hypertension. There’s a high probability that his blood pressure is a reflection of minor alcohol withdrawal, and you may find that treating his major problem will obviate having to treat minor side-effects like an elevated blood pressure. One generally does best to treat the patient, not his numbers.

  7. By only128onegame on Oct 1, 2008 | Reply

    First thing is he needs to stop smoking. Second he needs to reduce his weight. Then you can start on a Beta-Blocker. Beta-Blockers not only help with reducing BP but also reduce mortality. Along with the Beta-Blocker you may start him on a duiretic like Flurosemide (Lasix). The next step would be to start an ACE inhibitor or ARB.

  8. By Troy on Oct 2, 2008 | Reply

    First thing is you cannot diagnose hypertension from a single reading. You need at least two more.
    If he does have hypertension, the first thing is he needs to stop drinking so much, exercise more, lose weight, and stop smoking. Lifestyle modifications always come first. you wouldn’t let a 300 pound person keep eating 4000 Cal. a day, why would you not counsel this patient to stop his destructive habits?
    All of the above answers are at least partially correct. a 36 year old with stage II hypertension should be evaluated for a secondary cause. If one is found then you treat based on that. a Pheochromocytoma would be treated with surgical resection and an alpha 1 and beta blocker. Renal artery stenosis would be treated medically with ACE inhibitors ro angiotensin receptor blockers if possible, otherwise surgical correction would be necessary
    Beta blockers and CCBs are no longer recommended as first line agents, he should be put on a or a thiazide diuretic, probably including an ACE-Inhibitor with that high of a blood pressure. If those don’t bring down the BP enough then a CCB or beta blocker would be added.

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