A 55-year-old man with heart failure (EF 28%) develops angioneurotic edema on lisinopril and cannot tolerate an ARB because of persistent cough. Which combination therapy is recommended as replacement in this setting?

• A Digoxin plus furosemide alone
• B Verapamil plus low dose aspirin
• C Hydralazine plus isosorbide dinitrate ✓
• D Nifedipine plus atenolol

Explanation

The fixed combination of hydralazine and isosorbide dinitrate improves survival in heart failure and is the standard alternative when both ACE inhibitors and ARBs are not tolerated. Nitrates reduce preload and hydralazine reduces afterload by arterial dilation, together reducing wall stress. Verapamil is harmful in systolic failure because of its negative inotropy, nifedipine offers no mortality benefit, and digoxin plus furosemide relieves symptoms but does not improve survival.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.