Questions and Case Studies – Drugs in Hypertension

by Pravin Shukle, MD

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    Let's move on to some questions. The first question, a 60 year old man has high blood pressure and diabetes. He presents with severe swelling in the face and half of his tongue is really swollen. When you take a look at him, this is what he looks like. He had been given enalapril previously, hydrochlorothiazide, and an oral antidiabetic drug. Which of the drugs is the likely culprit? Is it aspirin? Is it enalapril, hydrochlorothiazide, the new unnamed diabetic drug, or this is some kind of an environmental allergy? Right, this is enalapril. Now, this patient is showing classical signs of angioedema, which is a relatively rare complication sometime seen in patients taking ACE inhibitors. It would be inadvisable to start an ARB, because there's a 10 % cross-reactivity between ACEi's and ARBs. Treatment is supportive and withdraw the medication. Angioedema often looks like the person has a huge red face as well, this is a more rare kind of presentation but remember, swelling in the face, redness in the face, or swelling of the tongue when you take a medication, think angioedema from the ACE inhibitor. This next question is kind of fun for me because this is actually a real patient. You have a 95 year old man with consistent blood pressures of 170/94. He is on no medications and he has no other diseases and looks 30 years younger than his stated age. You are considering starting him on an antihypertensive medication. Which statement is true? Number 1, do not use an ACE inhibitor as first line therapy. B, do not use a beta blocker as first line therapy. C, do not use a calcium channel blocker as first line therapy. D, do not use a direct renin inhibitor as first line therapy. And E, do...

    About the Lecture

    The lecture Questions and Case Studies – Drugs in Hypertension by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • Case Study 1: Hypertension
    • Case Study 2: Hypertension
    • Question 1: Hypertension

    Author of lecture Questions and Case Studies – Drugs in Hypertension

     Pravin Shukle, MD

    Pravin Shukle, MD

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