Which antihypertensive should generally be avoided in patients with asthma due to risk of bronchospasm?

• A. Angiotensin-converting enzyme inhibitors
• B. Nonselective beta blockers
• C. Calcium channel blockers
• D. Thiazide diuretics

Answer: (B)

Blocking beta-2 receptors in the airways can cause bronchoconstriction, so antihypertensives that block both beta-1 and beta-2 receptors are avoided in asthma. Nonselective beta blockers do exactly that, risking bronchospasm in patients with asthma, which is why they’re generally avoided. If a beta-blocker is ever considered, a cardioselective agent with careful monitoring might be used, but many clinicians prefer alternatives. Other listed classes don’t carry the same bronchospasm risk: ACE inhibitors, calcium channel blockers, and thiazide diuretics do not typically provoke bronchoconstriction, though each has separate side effects to consider.