In addition to verapamil, which medication is considered the treatment of choice for patients with hypertrophic cardiomyopathy?

• A. ACE inhibitors
• B. Beta-blockers
• C. Antiarrhythmics
• D. Alpha-agonists

Answer: (B)

Beta-blockade is the preferred approach in hypertrophic cardiomyopathy because slowing the heart rate and reducing contractility decreases the dynamic left ventricular outflow tract obstruction and improves diastolic filling. Verapamil can also reduce contractility, but adding a beta-blocker provides the most reliable relief of symptoms by blunting the obstruction and lowering oxygen demand. Other drugs either don’t address the obstruction effectively or can worsen it by decreasing preload or increasing afterload, so they’re not first-line.