Which medication may worsen the blood pressure in an angina patient already on a maximized dose of β-blocker?

The choice of verapamil as the medication that may worsen blood pressure in a patient with angina already on a maximized dose of β-blocker is based on its pharmacological effects. Verapamil is a non-dihydropyridine calcium channel blocker that primarily decreases heart rate and myocardial contractility. When used in conjunction with a β-blocker, which also reduces heart rate and contractility, there is a potential for additive effects that could lead to significant bradycardia or hypotension.

In a patient already maximized on a β-blocker, the addition of verapamil can result in excessive reductions in heart rate and blood pressure, which can exacerbate symptoms or lead to complications. Therefore, careful monitoring is required, and its use may not be advisable in this context due to the risk of worsened blood pressure or other adverse cardiovascular effects.

In contrast, medications like nifedipine and amlodipine are dihydropyridine calcium channel blockers that primarily lead to vasodilation rather than significant effects on cardiac contractility or conduction. Ranolazine, on the other hand, primarily works by modifying cardiac metabolism and does not have a direct impact on heart rate or blood pressure in the same way that ver