Which one of the following is the most appropriate drug to use for the patient described in parentheses?
A. Captopril (60-year-old woman with diabetic nephropathy)
B. Nitroprusside (50-year-old man with BP of 140/95)
C. Losartan (29-year-old pregnant woman)
D. Propranolol (40-year-old patient with peripheral vascular disease)
E. Milrinone (57-year-old patient with chronic CHF)
Answer: A. ACEIs slow the progression of diabetic nephropathy and are
indicated for management of HTN in such patients. Nitroprusside is used
IV in severe HTN or hyper¬tensive crisis, not for management of mild-tomoderate HTN. Losartan, which blocks AT-1 receptors, is associated with
teratogenic effects during fetal development, as are the ACEIs. Nonselective
beta blockers are not ideal for patients who suffer from peripheral vascular
disease, diabetes, or asthma. Milrinone, like most inotropes, is not useful
long-term in CHF patients. The drug has been shown to increase mortality
with chronic use, and thus is indicated for acute CHF. Digoxin is currently
the only inotrope used chronically