A 58-year-old man with hypertension and known coronary artery vasospastic (Prinzmetal) angina is being started on antihypertensive therapy. Which of the following agents is most likely to aggravate his anginal episodes?

• A Amlodipine
• B Verapamil
• C Nitrate monotherapy
• D Propranolol ✓

Explanation

In vasospastic angina the spasm is driven by alpha-mediated coronary vasoconstriction. Non-selective beta-blockade with propranolol removes beta-2 mediated vasodilation, leaving alpha vasoconstrictor tone unopposed, which can worsen or prolong coronary spasm. Calcium channel blockers such as amlodipine and verapamil relieve spasm, and nitrates are direct vasodilators, so all three are appropriate choices in this condition.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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