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Is it advisable to reduce the dose of BP medicine?

Friday, 28 July 2006
Answered by: Dr. Chandra M. Gulhati
Editor,
MIMS,
New Delhi
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Q. I have noticed that my blood pressure is 220/120 and at the same I have asthmatic attacks. My doctor says this was due to high BP. He started Minipress XL 2.5 in the morning and 5 mg in the night with the combination of Asomex LT. After 6 months, the doctor advised 2.5 mg instead of 5 mg in the night. After another six months, I am finding my BP maintained at a level of 120/80. I feel weakness in the leg joints. Is it advisable to reduce the Minipress XL dose to a tablet per day?

A.  It is quite likely that your so-called asthmatic attack (breathlessness) was due to very high blood pressure. With regard to your treatment, you are currently taking three medicines, namely: Minipress XL that contains prazosin; Asomex LT that contains two drugs i.e. amlodipine and losartan. It is not clear how you reached the three-drugs level. Was it not possible to control your blood pressure with lesser number of medicines? As per evidence-based international guidelines, the initial, first choice treatment of hypertensive patients under 55 years of age should be a drug belonging to ACE inhibitors class (such as enalapril sold under the brand names of BQL, Enam etc.). It is particularly suited in young, sexually active males since unlike other medicines such as prazosin; it does not cause erectile dysfunction (impotence). If enalapril in full dose (usually 10 mg twice daily) does not bring down the BP to target levels, then one should add either a low dose diuretic (such as indapamide sold under the trade name of Indicontin Continus - 1.5 mg once daily) or add amlodipine (sold under the brand names of Amlodac etc.) 5 mg daily. In a great majority of cases, the blood pressure is controlled. In exceptional cases, it may be necessary to use three drugs i.e. enalapril (BQL, Enam), amlodipine (Amlodac) and indapamide (Indicontin Continus). Non-drug measures such as weight reduction to normal levels, exercise (brisk walk for 45 minutes to cover no less than 4.5 km daily) and reduction of salt intake to 5 g or less must be taken simultaneously. Minipress causes nasal congestion i.e. choking of nose.

A.  It is quite likely that your so-called asthmatic attack (breathlessness) was due to very high blood pressure. With regard to your treatment, you are currently taking three medicines, namely: Minipress XL that contains prazosin; Asomex LT that contains two drugs i.e. amlodipine and losartan. It is not clear how you reached the three-drugs level. Was it not possible to control your blood pressure with lesser number of medicines? As per evidence-based international guidelines, the initial, first choice treatment of hypertensive patients under 55 years of age should be a drug belonging to ACE inhibitors class (such as enalapril sold under the brand names of BQL, Enam etc.). It is particularly suited in young, sexually active males since unlike other medicines such as prazosin; it does not cause erectile dysfunction (impotence). If enalapril in full dose (usually 10 mg twice daily) does not bring down the BP to target levels, then one should add either a low dose diuretic (such as indapamide sold under the trade name of Indicontin Continus - 1.5 mg once daily) or add amlodipine (sold under the brand names of Amlodac etc.) 5 mg daily. In a great majority of cases, the blood pressure is controlled. In exceptional cases, it may be necessary to use three drugs i.e. enalapril (BQL, Enam), amlodipine (Amlodac) and indapamide (Indicontin Continus). Non-drug measures such as weight reduction to normal levels, exercise (brisk walk for 45 minutes to cover no less than 4.5 km daily) and reduction of salt intake to 5 g or less must be taken simultaneously. Minipress causes nasal congestion i.e. choking of nose.

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