Which of the following is a first-line antihypertensive agent?

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Multiple Choice

Which of the following is a first-line antihypertensive agent?

A thiazide diuretic is a classic first-line choice for uncomplicated hypertension because it reliably lowers blood pressure with a strong track record of reducing cardiovascular events, and it does so with generally good tolerability and cost-effectiveness. It works by promoting sodium and water excretion, which reduces circulating volume and, over time, decreases peripheral resistance, producing durable BP control. Large trials have shown that thiazides, particularly chlorthalidone, confer meaningful reductions in stroke and heart attack risk, supporting their role as initial therapy. The other options play important roles in specific scenarios but are not typical first-line choices for uncomplicated hypertension. Non-selective beta-blockers can have less BP-lowering efficacy and may worsen metabolic parameters or provoke bronchospasm, limiting their use as initial therapy in a broad patient population. Hydralazine is a potent vasodilator mainly reserved for hypertensive emergencies or as add-on therapy, given risks like reflex tachycardia and fluid retention. Prazosin, an alpha-1 blocker, is associated with orthostatic hypotension and lacks consistent advantages in primary outcome prevention, making it unsuitable as a first-line agent.

A thiazide diuretic is a classic first-line choice for uncomplicated hypertension because it reliably lowers blood pressure with a strong track record of reducing cardiovascular events, and it does so with generally good tolerability and cost-effectiveness. It works by promoting sodium and water excretion, which reduces circulating volume and, over time, decreases peripheral resistance, producing durable BP control. Large trials have shown that thiazides, particularly chlorthalidone, confer meaningful reductions in stroke and heart attack risk, supporting their role as initial therapy.

The other options play important roles in specific scenarios but are not typical first-line choices for uncomplicated hypertension. Non-selective beta-blockers can have less BP-lowering efficacy and may worsen metabolic parameters or provoke bronchospasm, limiting their use as initial therapy in a broad patient population. Hydralazine is a potent vasodilator mainly reserved for hypertensive emergencies or as add-on therapy, given risks like reflex tachycardia and fluid retention. Prazosin, an alpha-1 blocker, is associated with orthostatic hypotension and lacks consistent advantages in primary outcome prevention, making it unsuitable as a first-line agent.

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