A 40-year-old politician suffered from attacks of chest pain diagnosed as angina pectoris. He had a tense personality, hea rate was 96/min blood pressure 170/104mm Hg, but blood sugar level and lipid profile were normal. Select the most suitable antihypeensive for the initial therapy in his case:

**Core Concept**
The underlying principle in this scenario is the management of hypertension in a patient with angina pectoris, where lifestyle modifications and pharmacological interventions are crucial to prevent cardiac events. The patient's normal blood sugar and lipid profile suggest that his hypertension is primarily due to non-modifiable risk factors such as age, gender, and possibly underlying stress.

**Why the Correct Answer is Right**
The patient's hypertension is likely due to a combination of factors, including stress and possible sleep apnea, given his tense personality and elevated heart rate. The presence of angina pectoris further emphasizes the need for an antihypertensive agent that will not compromise cardiac output or worsen myocardial oxygen demand. **Beta-blockers** are ideal in this scenario as they reduce heart rate, myocardial contractility, and cardiac output, thereby decreasing myocardial oxygen demand and alleviating angina symptoms. They also have a protective effect on the ischemic myocardium.

**Why Each Wrong Option is Incorrect**
**Option A:** Thiazide diuretics are not the first-line choice in this scenario as they can worsen angina by increasing myocardial oxygen demand due to their vasodilatory effect on the coronary arteries.
**Option B:** Angiotensin-converting enzyme inhibitors (ACEIs) are not the best choice as they do not directly reduce heart rate or myocardial contractility.
**Option C:** Calcium channel blockers (CCBs) may be a good alternative, but they are not as effective as beta-blockers in reducing myocardial oxygen demand in the setting of angina pectoris.

**Clinical Pearl / High-Yield Fact**
Beta-blockers are a cornerstone in the management of angina pectoris, and their use should be considered alongside lifestyle modifications and other pharmacological interventions to prevent cardiac events.

**Correct Answer:** C. Atenolol

✓ Correct Answer: C. Atenolol