Which medication is inappropriate for hypertension in older adults as a nonselective peripheral alpha-1 blocker?

• A. Lisinopril
• B. Amlodipine
• C. Guanfacine
• D. Doxazosin

Answer: (D)

Nonselective peripheral alpha-1 blockers can cause a pronounced drop in blood pressure when a person stands up, leading to dizziness, fainting, and falls—an especially dangerous combination for older adults. Doxazosin is an alpha-1 blocker with this nonselective peripheral action, so it’s considered inappropriate for hypertension management in the elderly according to Beers Criteria. The other meds listed work through different mechanisms: lisinopril is an ACE inhibitor, amlodipine is a calcium channel blocker, and guanfacine is a central alpha-2 agonist, none of which share the same orthostatic risk profile as nonselective peripheral alpha-1 blockade.