What is a recognized cause of coronary vasospasm?

Cocaine is a well-established cause of coronary vasospasm due to its potent sympathomimetic effects, which lead to increased catecholamine release and direct stimulation of alpha-adrenergic receptors. This stimulation causes vasoconstriction of coronary arteries, which can precipitate angina or even myocardial infarction, particularly in individuals with underlying coronary artery disease. The effect of cocaine on vascular tone is both acute and significant, making it a critical factor in understanding coronary vasospasm in certain patient populations.

In contrast, hydrochlorothiazide is a diuretic used primarily for the treatment of hypertension, and it is not associated with inducing coronary vasospasm. Beta-blockers, on the other hand, are typically prescribed to manage conditions such as hypertension and heart disease and work by reducing heart rate and myocardial oxygen demand. They are not linked to causing vasospasm; instead, they can often help prevent angina. Clonidine, primarily used as an antihypertensive, can sometimes cause sedation and bradycardia but does not have a direct role in promoting vasospasm. Hence, cocaine stands out as the clear answer due to its direct physiological effects on coronary vasculature.