A 62-year-old man visits the office for a hypertension check-up. He was diagnosed with hypertension ten years ago and has been treated with various medications. However, due to side effects such as dizziness, palpitations, and headaches, the patient has had to discontinue several medications. He is currently taking ramipril and chlorthalidone and tolerates them well. His blood pressure is 160/92 mm Hg, up from 158/89 mm Hg at his most recent visit. The ECG shows sinus bradycardia (55 beats per minute) with PR interval prolongation (280 msec). Which of the following medications would be most effective for lowering this patient's blood pressure without worsening his ECG abnormalities?

Question

A 62-year-old man visits the office for a hypertension check-up. He was diagnosed with hypertension ten years ago and has been treated with various medications. However, due to side effects such as dizziness, palpitations, and headaches, the patient has had to discontinue several medications. He is currently taking ramipril and chlorthalidone and tolerates them well. His blood pressure is 160/92 mm Hg, up from 158/89 mm Hg at his most recent visit. The ECG shows sinus bradycardia (55 beats per minute) with PR interval prolongation (280 msec).   Which of the following medications would be most effective for lowering this patient's blood pressure without worsening his ECG abnormalities?

Quizplus · Accepted Answer

Eductional Objective: Calcium channel blockers work by preventing the L-type calcium channel from opening in vascular smooth muscle and cardiac cells. Dihydropyridines (for example, nifedipine and amlodipine) primarily affect peripheral arteries, causing vasodilation. Nondihydropyridines (such as verapamil and diltiazem) have an effect on the myocardium, causing bradycardia and slowed atrioventricular conduction.

A 62-Year-Old Man Visits the Office for a Hypertension Check-Up