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

Pharmacological reasoning approach:

Clinical scenario: hypertension + peripheral edema + CKD.

Analysis of options:

Option A -- Aliskiren (direct renin inhibitor):
- Contraindicated in CKD, especially with ACE inhibitors or ARBs
- Risk: hyperkalemia, acute kidney injury -- NOT preferred

Option B -- Chlorthalidone (thiazide-like diuretic):
- Dual action: antihypertensive + diuretic (addresses both HTN and edema)
- Unlike HCTZ, chlorthalidone is effective even when GFR is 30-45 ml/min
- Longer half-life (45-60 hrs) than HCTZ -- better 24-hr BP control
- First-line antihypertensive per JNC guidelines
- PREFERRED in HTN + CKD + edema

Option C -- Prazosin (alpha-1 blocker):
- Causes first-dose hypotension
- No diuretic benefit; does not address edema
- Not first-line in CKD

Option D -- Beta blockers:
- Useful for HTN but no significant diuretic effect
- Not preferred when edema is the co-existing problem

\[\boxed{\text{Chlorthalidone}}\]