A 77-year-old man comes to the office after he was found to have high blood pressure during a health fair. The patient denies any medical problems and feels proud that he has not needed to see a doctor for many years. His blood pressure is 170/70 mm Hg and pulse is 74/min. Other physical examination findings are normal. The patient is started on a medication to treat his hypertension. During his follow-up visit 3 weeks later, he reports bilateral leg swelling. He has no chest pain, shortness of breath, or abdominal symptoms. His blood pressure is 135/65 mm Hg and pulse is 80/min. Cardiopulmonary examination is normal, but there is bilateral, symmetrical, 2+ pitting lower extremity edema. Laboratory studies show serum creatinine of 0.8 mg/dL, and urinalysis is negative for proteinuria. Which of the following was most likely prescribed to treat this patient's hypertension?

Question

A 77-year-old man comes to the office after he was found to have high blood pressure during a health fair.  The patient denies any medical problems and feels proud that he has not needed to see a doctor for many years.  His blood pressure is 170/70 mm Hg and pulse is 74/min.  Other physical examination findings are normal.  The patient is started on a medication to treat his hypertension.  During his follow-up visit 3 weeks later, he reports bilateral leg swelling.  He has no chest pain, shortness of breath, or abdominal symptoms.  His blood pressure is 135/65 mm Hg and pulse is 80/min.  Cardiopulmonary examination is normal, but there is bilateral, symmetrical, 2+ pitting lower extremity edema.  Laboratory studies show serum creatinine of 0.8 mg/dL, and urinalysis is negative for proteinuria.  Which of the following was most likely prescribed to treat this patient's hypertension?

Quizplus · Accepted Answer

11ec160b_3b81_b44e_9249_3f04107625ba_MD0001_00 Dihydropyridine calcium channel blockers (eg, amlodipine, nifedipine) are effective antihypertensive agents commonly used as monotherapy or in combination with other agents for treatment of hypertension. The major side effects associated with use of calcium channel blockers include headache, flushing, dizziness, and peripheral edema. Development of peripheral edema is related to preferential dilation of precapillary vessels (arteriolar dilation), which leads to increased capillary hydrostatic pressure and fluid extravasation into the interstitium. Renin-angiotensin system blockers (eg, ACE inhibitors or angiotensin II receptor blockers [ARBs]) cause postcapillary venodilation and can normalize the increased capillary hydrostatic pressure, reducing the risk of peripheral edema in patients taking calcium channel blockers. (Choice B) Eplerenone is an aldosterone antagonist and functions similarly to spironolactone as a potassium-sparing diuretic. The most frequent side effects of eplerenone are hyperkalemia, increased creatinine, and gynecomastia (~1% versus 10% with spironolactone). (Choices C and E) The most common side effects of thiazide (eg, hydrochlorothiazide) and loop diuretics (eg, torsemide) are electrolyte abnormalities such as hypokalemia, hyponatremia, and hypomagnesemia. They do not cause peripheral edema. (Choices D and F) The potential side effects of ACE inhibitors (eg, ramipril) and ARBs (eg, valsartan) include cough, hypotension, hyperkalemia, and angioedema. The risk of cough and angioedema is much lower with ARBs. These medications do not cause peripheral edema. Educational objective: Amlodipine is a dihydropyridine calcium channel blocker commonly used as monotherapy or in combination with other agents for treatment of hypertension. Major side effects include headache, flushing, dizziness, and peripheral edema. __________ References: Vasodilatory edema: a common side effect of antihypertensive therapy. (http://www.ncbi.nlm.nih.gov/pubmed/12379167) Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate - a meta-analysis of randomized trials. (http://www.ncbi.nlm.nih.gov/pubmed/21558959)

A 77-Year-Old Man Comes to the Office After He Was