A 58-yeаr-оld mаn presents tо yоur clinic for mаnagement of newly diagnosed hypertension with blood pressure readings consistently 150/95 mm Hg. His past medical history includes type 2 diabetes mellitus (on insulin), moderate persistent asthma (well-controlled on inhaled corticosteroids and long-acting beta-agonists), and peripheral arterial disease with intermittent claudication. His resting heart rate is 72 beats per minute, and his ECG shows normal sinus rhythm with a PR interval of 0.18 seconds. Which of the following represents an absolute contraindication to initiating beta blocker therapy for this patient's hypertension?
Jоe's аsthmа hаs been well-cоntrоlled for the past 6 months on controller therapy of Advair 250mcg/50mcg and short-acting beta-agonist (SABA) as needed. Today he presents with complaint of an upper respiratory infection (URI) that started 1 week ago. Reports frequent, nonproductive cough that keeps him awake and increased wheezing that requires use of her SABA MDI 6-8 times daily. Denies fever, chills, nausea or vomiting. On physical exam: appears to be in mild distress, vital signs- T 98.9, P 96, R 22, O2 sat 96%. Lungs have expiratory wheezes throughout bilaterally, with good air movement, no dullness to percussion. The remainder of the physical exam is normal. Your diagnosis is acute asthma exacerbation. The most appropriate therapy to initiate at this time includes: