For a patient discharged after angioedema attributed to an ACE inhibitor, what is the next best medication to initiate for hypertension?

In the scenario of a patient who has experienced angioedema attributed to an ACE inhibitor, the next best medication to initiate for hypertension is a calcium channel blocker, such as amlodipine. The rationale for this choice lies in the mechanism of action and safety profile of the medication.

Amlodipine is a dihydropyridine calcium channel blocker that effectively lowers blood pressure by relaxing blood vessels, improving blood flow. It does not carry the same risk of angioedema that ACE inhibitors do, making it a safer alternative for patients who have had reactions to ACE inhibitors. This is especially important when selecting antihypertensive therapy following a serious adverse reaction.

In contrast, medications like losartan (an angiotensin receptor blocker) and lisinopril (an ACE inhibitor) would not be appropriate due to their association with similar risks of angioedema. Hydrochlorothiazide, while effective in managing hypertension, is generally not the first-line option for patients with a history of angioedema from an ACE inhibitor, as it doesn’t have as robust a blood pressure-lowering effect as amlodipine in certain populations.

Thus, amlodipine is the preferred choice, providing effective blood pressure control