1.73-year-old male who is a smoker has a BMI of 28 and is newly diagnosed with primary HTN. He has a history of emphysema and second-degree AV block. His BP from the previous visit is 145/80 mmHg. During the current visit, his BP is 155/80 mmHg. What is the next step?

• Start patient on atenolol (Ternomin) 50 mg once a day and reassess in 3 months
• Start patient on felodipine (Cabren) 2.5 mg once a day and reassess in 2 months
• Start patient on chlorthalidone 12.5 mg daily and reassess in 1 month
• No medication is needed at this time

ANSWER

The next step in managing the 73-year-old male with newly diagnosed primary hypertension (HTN), a history of emphysema, second-degree AV block, and a BP of 155/80 mmHg during the current visit involves considering the most appropriate treatment option. In this case, the patient’s history of emphysema and second-degree AV block should guide the choice of antihypertensive medication to avoid exacerbating these conditions while effectively managing HTN.

Given the patient’s history, the most suitable initial antihypertensive option would be to start him on felodipine (Cabren) 2.5 mg once a day and reassess his BP in 2 months. Felodipine is a calcium channel blocker that primarily affects the smooth muscle of the arteries, causing vasodilation and reducing systemic vascular resistance. This medication has a favorable side effect profile with minimal impact on the respiratory and cardiac systems. Since the patient has a history of emphysema and second-degree AV block, it’s important to avoid medications that can exacerbate respiratory symptoms or adversely affect cardiac conduction.

This choice takes into account the patient’s medical history, current BP reading, and the need to manage hypertension effectively while considering his existing health conditions. Regular monitoring and follow-up appointments will allow for adjustments to the treatment plan as necessary to achieve optimal blood pressure control and overall health management.