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Am I taking the right medications for treating high BP?

Wednesday, 11 February 2009
Answered by: Dr. Chandra M. Gulhati
Editor,
MIMS,
New Delhi
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Q. I am a 42 years old man having hypertension and was taking Telma 40, Nebicard 5 and Colsprin 100 for the last 2 years. Then I developed erectile dysfunction and hence stopped Nebicard 5 for the last month. Recently, I consulted the doctor and he suggested using Telma AM and Ecosprin 150; with these medications my blood pressure was 140-155/90-105 mm Hg. He has now prescribed Natrilix SR along with Telma-AM and Ecosprin-150. Is the treatment correct?

A.  Nebicard contains nebivolol which is known to cause not only ED but also can precipitate diabetes; hence it is not a first line drug in young patients of high blood pressure. Telma contains telmisartan. Telma-AM telmisartan and amlodpine. There was a time when individual doctors based on their own perception used to prescribe medicines for high blood pressure. Thus if a patient went to three different doctors, he or she may get three different prescriptions. In the past 10 years or so, based on worldwide data (results based on clinical trials on thousands of patients) international guidelines on the treatment of high blood pressure have been issued. In sexually active male patients younger than 55, first choice initial therapy should be enalapril (sold as Enam) 5-10 mg 1-2 times daily. In some patients, enalapril may give rise to cough. In such cases losartan (sold as Losacar) 50mg once daily or telmisartn (sold as Telma) can be used. Earlier you were on two drugs: telmisartan (Telma) and nebivolol (Nebicard). Now you have been prescribed three drugs: Indapamide (Natrilix SR) and Telma-AM (telmisartan + amlodipine). I should think that an attempt should be made to see if two drugs i.e. Natrilix SR and Telma-40 do not control the blood pressure before adding third drug. Of course one can also try enalapril (Enam) with Natrilix SR. The objective is to use as few drugs as possible at such a young age.

A.  Nebicard contains nebivolol which is known to cause not only ED but also can precipitate diabetes; hence it is not a first line drug in young patients of high blood pressure. Telma contains telmisartan. Telma-AM telmisartan and amlodpine. There was a time when individual doctors based on their own perception used to prescribe medicines for high blood pressure. Thus if a patient went to three different doctors, he or she may get three different prescriptions. In the past 10 years or so, based on worldwide data (results based on clinical trials on thousands of patients) international guidelines on the treatment of high blood pressure have been issued. In sexually active male patients younger than 55, first choice initial therapy should be enalapril (sold as Enam) 5-10 mg 1-2 times daily. In some patients, enalapril may give rise to cough. In such cases losartan (sold as Losacar) 50mg once daily or telmisartn (sold as Telma) can be used. Earlier you were on two drugs: telmisartan (Telma) and nebivolol (Nebicard). Now you have been prescribed three drugs: Indapamide (Natrilix SR) and Telma-AM (telmisartan + amlodipine). I should think that an attempt should be made to see if two drugs i.e. Natrilix SR and Telma-40 do not control the blood pressure before adding third drug. Of course one can also try enalapril (Enam) with Natrilix SR. The objective is to use as few drugs as possible at such a young age.

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