Uworld Q on treatment of Peripheral Vascular Disease, mistake???

[medInUSA]

66 yo male five months of intermittent claudication. HIs BP is 155/95 and heart rate is 70. Which of the following meds is the best choice to control this patient's hypertension?

A) Amlodipine
B) Enalapril

their answer is Amlodipine:
"the best initial choice for the treatment of hypertension in this patient seems to be dihydropyridine calcium channel blocker like amlodipine. Calcium channel blockers have a good peripheral vasodilating properties that can help to diminish the symptoms of intermittent claudication. They are also metabolically neutral, not affecting plasma lipid profile"

"Enalapril, an ACE inhibitor can be considered but it would not relieve the symptoms of intermittent claudication"

"Educational Objective : In patients presenting with significant peripheral vascular disease calcium channel blockers are preferred as anti hypertensive agents"


Now according to conrad fisher, usmle master the boards step 3 page 71
the best initial therapy for hypertension in peripheral arterial disease is ACE inhibitors.
On the same page Fisher also states specifically " Calcium Challen Blockers are ineffective therapy"

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[medInUSA]

According to Harrison's, in the treatment of peripheral vascular disease:


"It is important to control blood pressure in hypertensive patients. Angiotensin-converting enzyme inhibitors may reduce the risk of cardiovascular events in patients with symptomatic PAD. -Adrenergic blockers do not worsen claudication and may be used to treat hypertension, especially in patients with coexistent coronary artery disease. Treatment of hypercholesterolemia with statins is advocated to reduce the risk of myocardial infarction, stroke and death. "

again no mention of calcium channel blockers.

 

[Scaredshizzles]

66 yo male five months of intermittent claudication. HIs BP is 155/95 and heart rate is 70. Which of the following meds is the best choice to control this patient's hypertension?

A) Amlodipine
B) Enalapril

their answer is Amlodipine:
"the best initial choice for the treatment of hypertension in this patient seems to be dihydropyridine calcium channel blocker like amlodipine. Calcium channel blockers have a good peripheral vasodilating properties that can help to diminish the symptoms of intermittent claudication. They are also metabolically neutral, not affecting plasma lipid profile"

"Enalapril, an ACE inhibitor can be considered but it would not relieve the symptoms of intermittent claudication"

"Educational Objective : In patients presenting with significant peripheral vascular disease calcium channel blockers are preferred as anti hypertensive agents"


Now according to conrad fisher, usmle master the boards step 3 page 71
the best initial therapy for hypertension in peripheral arterial disease is ACE inhibitors.
On the same page Fisher also states specifically " Calcium Challen Blockers are ineffective therapy"

It's just an old question I'm guessing...CCB used to be considered first line in PAD...But truth is they do little to help PAD symptoms, have no effect on long term prognosis, and now new concerns about CCBs have come in recent years in terms of cardiac mortality. BB's are still considered a no-no in many circles due to unbalanced alpha-stimulation and potential for further vasoconstriction....ACEi's probably won't help PAD symptoms at all, but pretty much anyone with advanced PAD has evidence of CAD and renal insufficiency too.

 

[Labslave]

It's just an old question I'm guessing...CCB used to be considered first line in PAD...But truth is they do little to help PAD symptoms, have no effect on long term prognosis, and now new concerns about CCBs have come in recent years in terms of cardiac mortality. BB's are still considered a no-no in many circles due to unbalanced alpha-stimulation and potential for further vasoconstriction....ACEi's probably won't help PAD symptoms at all, but pretty much anyone with advanced PAD has evidence of CAD and renal insufficiency too.

This post is spot on.

It's a bad question in the first place. The question on the real deal would most likely center around recognizing a host of contraindications to using other drugs or a situation in which there is a CLEAR benefit of using one drug over another.