TR is a 65 year old male who has been perfectly healthy for his whole life. Today, he has been diagnosed with uncomplicated hypertension. In the absence of compelling indications, which of the following medications is NOT recommended as first-line therapy?
a) Hydrochlorothiazide
b) Amlodipine
c) Lisinopril
d) Bisoprolol
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(D) is the correct answer.
For uncomplicated hypertension without compelling indications, the CHEP hypertension recommend to choose from thiazide/thiazide-like diuretics, calcium channel antagonists, ACE inhibitors, ARB and beta blockers (if under 60 years old). With this caveat, TR should not receive a beta blocker such as bisoprolol because he is over 60 years old. The reason behind this is that beta-blockers do not effectively reduce cardiovascular morbidity and mortality compared to the other options. Other explanations may also because of reduced responsiveness by beta-adrenergic receptors towards beta-blockers in the geriatric population. Of course, beta-blockers can be used if there are compelling indications such as stroke or myocardial infaction.
a) Hydrochlorothiazide is a thiazide diuretic, which is one of the first line options.
b) Amlodipine is a calcium channel antagonist, which is one of the first line options.
c) Lisinopril is an ACE inhibitor, which is one of the first line options.
d) Correct answer
Note: there is a new 2020 update to the CHEP guidelines. Be sure to check it out!
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