Which antihypertensive medication should not be given to an older adult with esophageal stricture?

Doxazosin is an alpha-1 adrenergic blocker used to treat hypertension and symptoms of urinary retention in men with benign prostatic hyperplasia. However, it can cause relaxation of smooth muscle, which may lead to a decrease in blood pressure or cause symptoms such as dizziness or lightheadedness.

In older adults, especially those with comorbidities such as an esophageal stricture, there is an increased risk of complications when medications alter muscle tone or motility in the gastrointestinal tract. Since doxazosin may contribute to reduced motility or exacerbate dysphagia (difficulty swallowing), it is advisable to avoid this medication in patients with esophageal strictures, where maintaining esophageal function is crucial for safe eating and swallowing.

Other antihypertensive medications listed, such as losartan (an angiotensin II receptor blocker), hydralazine (a direct vasodilator), and propranolol (a non-selective beta blocker), do not have the same potential complications related to esophageal motility and stricture management, making them more suitable options for older adults in this situation.