Question

Hypertension with peripheral edema and CKD. Which drug is preferred?

• A. Aliskiren
• B. Chlorthalidone
• C. Prazosin
• D. Beta blocker

Hint:

In hypertension with fluid retention and CKD, a diuretic that also lowers blood pressure is the drug of choice.

Answer 1

The Correct Option is B

Step 1: Understand the clinical scenario.
Patient has: (1) Hypertension, (2) Peripheral edema (fluid retention), (3) Chronic kidney disease (CKD).

Step 2: Evaluate each drug option.

• Aliskiren: direct renin inhibitor; contraindicated in CKD, especially in combination with ACE inhibitors or ARBs; risk of hyperkalemia and renal impairment.
• Chlorthalidone: thiazide-like diuretic; first-line antihypertensive, controls both hypertension and edema; effective even in moderate CKD (unlike hydrochlorothiazide, chlorthalidone retains efficacy down to GFR 30 ml/min); preferred in hypertension with CKD and edema.
• Prazosin: alpha-1 blocker; not first-line for hypertension with CKD; risk of first-dose hypotension; does not address edema.
• Beta blocker: useful for hypertension but does not address peripheral edema; not first-line in CKD with edema.

Step 3: Conclusion.
Chlorthalidone is the preferred drug. It is a long-acting thiazide-like diuretic that reduces blood pressure and also reduces fluid overload (peripheral edema). It lowers blood pressure by reducing blood volume through diuresis, preventing strokes, heart attacks, and kidney deterioration.