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How to lower my blood pressure?

Answered by: U. Kaul
Director, Interventional Cardiology & Cardiac Electrophysiology,
Batra Hospital,
New Delhi

Q. I am a hypertensive male aged 45y (weight 104kg & height 180cm) with a family history of high blood pressure but negative for ischemic heart disease. I take a brisk walk for 50 minutes daily. I am taking following medicines : Amlodepine 5 mg 1 bd morning - night Atenolol 50 mg morning Atenolol 25 mg night Enalpril 10 mg with Hydrochlorthiazide 25 once at noon TG TOR 5 mg once at night Neasyn SR 500 at night Ecosprin 75 at night Query 1: Enalpril HT causes a lot of cough, so much so that my voice has become hoarse and cough irritates me. I am doing well with hypertension. But because of the side effect, I am requesting you for alternative drug having same effect and power. Query 2: TMT Normal - METS 11 : 115% of THR achieved . 2D Echo says Trivial MR with Mild MVP and Reduced LV Compliance. Lipid Normal but taking TG TOR 5 as maintenance dose : Here the doctor says hypertensive patient should take 10 mg Atorvastatin as per latest studies. Should I take 10 mg even when my lipid profile is normal? My HDL is only 33 kindly suggest medicine. Is there any lipid lowering medicine of reputed company which controls cholesterol and improves HDL? i.e.Atorvastatin + Nictonic Acid ? Query 3: Doctor insists that I need to take Aspirin 75 as prophylaxis. He says aspirin may or may not benefit but certainly does not cause damage. Your valuable guidance whether to continue to take or not?

A.  I think you are on a good and scientifically proven drugs. 1. If enalapril gives you cough which is becoming a nuisance, you could be started on Losartan 50 to 100 mgs as per your need. This medicine has most good properties of enalapril and cough is usually not a problem. 2. MVP is a an echo finding frequently reported on echo but has no significance and should be ignored as long as MR is trivial to mild. Decreased compliance could be a part of hypertension and BP control to levels close to 120/80 is the best way of containing it. 3. Atorvastatin 10 mgs is recommended in all hypertensives and is recommended irrespective of lipid levels. Higher doses are required if LDL cholesterol is more than 100 mgs despite 10 mgs. Niacin is a good drug to increase HDL cholesterol and dose can be increased to 2 gms under medical supervision if need be. Exercise, low salt diet and alcohol in moderation is also very effective concomitant therapy.

A.  I think you are on a good and scientifically proven drugs. 1. If enalapril gives you cough which is becoming a nuisance, you could be started on Losartan 50 to 100 mgs as per your need. This medicine has most good properties of enalapril and cough is usually not a problem. 2. MVP is a an echo finding frequently reported on echo but has no significance and should be ignored as long as MR is trivial to mild. Decreased compliance could be a part of hypertension and BP control to levels close to 120/80 is the best way of containing it. 3. Atorvastatin 10 mgs is recommended in all hypertensives and is recommended irrespective of lipid levels. Higher doses are required if LDL cholesterol is more than 100 mgs despite 10 mgs. Niacin is a good drug to increase HDL cholesterol and dose can be increased to 2 gms under medical supervision if need be. Exercise, low salt diet and alcohol in moderation is also very effective concomitant therapy.

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