**Question:** Aggravation of symptoms of angina in a patient when given nitrates is seen in:

**Core Concept:** Nitrates are a class of medications used to improve blood flow and relieve chest pain in patients with angina. They work by dilating blood vessels and reducing the workload on the heart. However, in certain patients, the response to nitrates can be paradoxical, leading to worsening of symptoms. This phenomenon is known as nitrate-induced angina.

**Why the Correct Answer is Right:** In this scenario, the correct answer is C (hypertension). When nitrates are administered, they cause systemic vasodilation, leading to a decrease in blood pressure. In patients with hypertension, this drop in blood pressure may exacerbate the symptoms of angina due to the reduced blood flow and oxygen supply to the heart muscle.

**Why Each Wrong Option is Incorrect:**
A (Cardiac ischemia) is not the correct answer because nitrates are primarily used to improve blood flow and relieve chest pain in patients with angina. The worsening of symptoms upon nitrate administration contradicts their intended purpose.

B (Pericarditis) is incorrect as it represents inflammation of the pericardium, not a response to nitrates. This option is unrelated to the pharmacological action of nitrates and their interaction with angina symptoms.

D (Pulmonary hypertension) is not relevant because the question focuses on the response to nitrates in the context of angina. Pulmonary hypertension is a separate condition unrelated to the mechanism of nitrates and their effect on angina symptoms.

**Clinical Pearl:** This example highlights the importance of considering individual patient responses when administering medications. In some cases, the pharmacological effects of nitrates may exacerbate symptoms rather than alleviate them, highlighting the necessity of a thorough understanding of each patient's condition and the potential paradoxical effects of certain therapies.

**Correct Answer:** C (Hypertension) demonstrates the potential paradoxical effects of nitrates in certain patients, emphasizing the importance of considering individual patient responses and clinical context when prescribing medications. This understanding is crucial for effective treatment and minimizing complications in patients with angina.