5th July 2024

A 45-year-old gentleman presents to ED with complaints of shortness of breath, headache and poor urine output

A 45-year-old gentleman presents to ED with complaints of shortness of breath, headache and poor urine output. He was recently referred for upper GI endoscopy by his GP for dysphagia. He does not take any regular medications. On examination, his BP was 190/110 mmHg. There are small ulcerations in multiple finger tips. He tells you that his finger changes colour to white, blue and red on exposure to cold.

Investigations show: Hb 90g/L (115-165), WBC 6×10⁹/L (4-11), Neutrophils 4.5×10⁹/L (2-8), Platelets 90×10⁹/L (150-400), Na 140 mmol/L (135-145), K 5.3 mmol/L (3.5-5), Urea 9.8 mmol/L (2.5-7.5), Creatinine 236 μmol/L (60-110). Urine Dipstick Showed 2+ protein and 1+ Blood.

What is the most appropriate agent to control BP in this case?

Select the SINGLE most appropriate option from the list below. Select ONE option only.