A 66-year-old woman presents to her physician for her annual examination. Her medical history is significant for hypertension and osteopenia. She is compliant with her medications and takes benazepril and a daily multivitamin with high calcium and vitamin D. She does not smoke and does weight-bearing exercises 4 times weekly. She denies any falls or previous fractures. On examination, her blood pressure is 164/94 mmHg and her heart rate is 89 beats per minute.
Which of the following medications should be added to her current regimen?
A. HydrochlorothiazideHydrochlorothiazide. This patient has poorly controlled hypertension on an ACE inhibitor, and therefore the dose should be increased or another agent should be added. Because this woman also has osteopenia, a thiazide diuretic would be an excellent option due to its effect of increasing the reabsorption of calcium in the nephron. (B) Furosemide is a loop diuretic and would cause increased calcium excretion in the urine, and thus would not be a good option for this patient. (C) A β-blocker does not address any of the patient’s comorbidities, and so a thiazide diuretic is a better option. (D) A bisphosphonate should be started if the patient has diagnosed osteoporosis (DEXA scan T-score ≤−2.5) or a previous fragility fracture; this patient has osteopenia (DEXA scan T-score between −1 and −2.5).