Which medication is preferred for initial hypertension management in a patient with autosomal dominant polycystic kidney disease?

The preferred medication for initial hypertension management in a patient with autosomal dominant polycystic kidney disease is lisinopril. This is primarily due to the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors on renal function and blood pressure control. Lisinopril not only lowers blood pressure effectively but also provides renal protective benefits, which is particularly important in patients with polycystic kidney disease who are at increased risk for progressive renal insufficiency.

ACE inhibitors like lisinopril can help reduce the hyperfiltration injury to nephrons caused by hypertension, thus potentially slowing the progression of kidney disease in these patients. The use of lisinopril is supported by clinical guidelines and evidence indicating improved outcomes for patients with chronic kidney disease and hypertension.

Other options may lower blood pressure but do not provide the same renal protective effects. For instance, while amlodipine and hydrochlorothiazide may be effective antihypertensive agents, they lack the specific renal benefits associated with ACE inhibitors. Similarly, losartan, although an angiotensin receptor blocker that might be beneficial in some cases, is not the first-line choice over lisinopril due to its slightly different mechanisms and less established benefit in this specific patient