Which antihypertensive medication is not recommended for patients with chronic obstructive pulmonary disease (COPD) and asthma?

Choice A rationale
A Ventricular Septal Defect (VSD) is a hole in the wall separating the two lower chambers of the heart. While it can cause cyanosis, it’s typically not associated with cyanosis during crying or feeding.
Choice B rationale
An Atrioventricular Canal (AVC) defect is a combination of heart problems resulting in a defect in the center of the heart. While it can cause cyanosis, it’s typically not associated with cyanosis during crying or feeding.
Choice C rationale
Tetralogy of Fallot is a congenital heart condition characterized by four anatomical abnormalities of the heart. It is the most common cyanotic heart defect and the most common cause of blue baby syndrome. Cyanosis, which is caused by a lack of oxygen in the blood, is often seen during periods of activity, such as feeding or crying.
Choice D rationale
An Atrial Septal Defect (ASD) is a hole in the wall between the two upper chambers of your heart (atria). While it can cause cyanosis, it’s typically not associated with cyanosis during crying or feeding.

Choice A rationale
Propranolol (Inderal) is a beta-adrenergic receptor blocker, also known as a beta-blocker. Beta-blockers can increase airway reactivity and may interfere with the activity of beta-agonists. They should be used with great caution or not at all in patients with chronic asthma.
However, beta blockers are safe for use in most patients with COPD, but less so in patients with asthma. Therefore, Propranolol (Inderal) is not recommended for patients with chronic obstructive pulmonary disease (COPD) and asthma.
Choice B rationale
Captopril (Capoten) is an ACE inhibitor, which is among the most widely used antihypertensive drugs. They are not contraindicated in asthma or COPD, but they can induce a bothersome cough that, although not damaging to the lungs, can be confused with cough due to underlying pulmonary diseases such as asthma and COPD1.
Choice C rationale
Diltiazem (Cardizem) is a calcium antagonist. There is no specific contraindication for using calcium antagonists in patients with COPD or asthma. These medications work by relaxing the muscles of your heart and blood vessels, but they do not have a direct effect on airway reactivity or lung function.
Choice D rationale
Hydrochlorothiazide (HydroDIURIL) is a diuretic. Diuretics help your body get rid of excess salt and water, primarily by stimulating your kidneys. They do not have a direct effect on airway reactivity or lung function, and there is no specific contraindication for using them in patients with COPD or asthma.