Question

Let A = ACE inhibitor, B = beta blocker, C = calcium channel blocker, and D = diuretic. For an elderly patient with hypertension, the antihypertensive drug of choice is?

• A. A or D
• B. A or B
• C. A or C
• D. C or D

Hint:

Elderly patients are low-renin, so favour the renin-independent arm of the AB/CD rule.

Answer 1

The Correct Option is D

Step 1: Antihypertensive therapy is structured by the AB/CD rule. A and B (ACE inhibitor and beta blocker) act mainly by suppressing the renin-angiotensin system and tend to work better in younger patients who have high renin. C and D (calcium channel blocker and diuretic) work independently of renin and are preferred in older patients and in those of African origin, who typically have a low-renin, volume-dependent pattern.

Step 2: In the elderly, renin activity is low, so renin-targeting drugs are less effective as first-line agents. Calcium channel blockers and diuretics give better blood pressure control in this group, which is why C or D is the answer (option d).

Step 3: The other combinations all pair in a renin-dependent agent (A or B), which is the preferred starting choice for the younger high-renin patient, not the elderly. Hence A or D, A or B and A or C are not the best fit here.