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Pharmacology · patient case with 1 question

Hypertensive patient on lisinopril

Patient: 58-year-old man presenting for routine restorative care.

Chief complaint: Broken filling on a lower right molar.

History: Hypertension for six years, controlled on lisinopril 20 mg daily. Reports an occasional dry cough. No other medications.

Findings: BP 128/78. Fractured MOD amalgam on tooth 30, no pulpal symptoms.

Question 1

Which BEST describes the mechanism by which his antihypertensive lowers blood pressure?

  1. Direct blockade of L-type calcium channels in vascular smooth muscle
  2. Reduced cardiac oxygen demand through beta-1 blockade
  3. Increased sodium and water excretion at the distal tubule
  4. Arteriolar dilation from reduced angiotensin II formation
Show answer and explanation

Correct answer: D. Arteriolar dilation from reduced angiotensin II formation

  • A. Calcium channel blockade is the mechanism of amlodipine and nifedipine.
  • B. Reduced cardiac demand through beta-1 blockade describes metoprolol and atenolol.
  • C. Natriuresis at the distal tubule describes thiazide diuretics such as hydrochlorothiazide.
  • D. CORRECT. Lisinopril is an ACE INHIBITOR. Blocking angiotensin-converting enzyme reduces conversion of angiotensin I to angiotensin II, the potent arteriolar constrictor. Less angiotensin II means arteriolar DILATION, lower peripheral resistance, and lower blood pressure. Reduced aldosterone and accumulated bradykinin (hence the dry cough) complete the picture.

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