Cardiovascular: ACE inhibitor first-dose hypotension: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular: ACE inhibitor first-dose hypotension

Sample item

A patient already on a high dose of furosemide for heart failure is given his first dose of captopril and becomes dizzy and hypotensive. What predisposed him?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Activation of the renin-angiotensin system due to volume depletion

When the renin-angiotensin system is strongly activated by diuretics or sodium depletion, blood pressure depends heavily on angiotensin II, and the first ACE inhibitor dose can cause abrupt hypotension. A low test dose and temporary diuretic reduction avoid this.

Option by option

  • A. Increased bradykinin only

    Bradykinin explains cough and angioedema, not first-dose hypotension.

  • B. Excess potassium retention

    Potassium retention causes hyperkalaemia, not acute hypotension.

  • C. Activation of the renin-angiotensin system due to volume depletion (correct)

    Correct. Angiotensin-dependent blood pressure is vulnerable to ACE inhibition.

  • D. Allergy to sulfonamide

    Sulfonamide allergy is not the mechanism.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Activation of the renin-angiotensin system due to volume depletion. When the renin-angiotensin system is strongly activated by diuretics or sodium depletion, blood pressure depends heavily on angiotensin II, and the first ACE inhibitor dose can cause abrupt hypotension.

Why is "Increased bradykinin only" not the answer?

Bradykinin explains cough and angioedema, not first-dose hypotension.

Why is "Excess potassium retention" not the answer?

Potassium retention causes hyperkalaemia, not acute hypotension.

Why is "Allergy to sulfonamide" not the answer?

Sulfonamide allergy is not the mechanism.

What concept does this question test?

It tests Cardiovascular: ACE inhibitor first-dose hypotension in Pharmacology. A low test dose and temporary diuretic reduction avoid this.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular: ACE inhibitor first-dose hypotension?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.