Am I on a correct medicine for hypertension?
Q: I am a 32 years old female. One month ago I was found to have high blood pressure. The reading was 150/100 mm of Hg. Initially, my doctor prescribed ramistar 2.5 mg but discontinued it after five days as my pressure remained at 150/90 mm of Hg. Then he prescribed amloz-at 25 mg (amlodipine plus atenolol) twice daily. My question is that I have read in your site that atenolol has a unacceptable risk of precipitating diabetes even in non-diabetic people. I have taken this medicine for two weeks and have been advised to continue it for a month as my pressure has been controlled in these two weeks, which is 120/86 mm of Hg now. Please tell me whether this medication is safe for me or not?
A:There are standard, global guidelines on the management of high blood pressure both in young (below 55 years of age) and elderly patients. When the high blood pressure is detected for the first time, at least two readings should be taken on both arms, while sitting and standing. The patient should be asked to reduce salt intake and undertake mild exercise such as brisk walk for 45 minutes to cover no less than 4.5 km daily for at least two weeks and advice on dealing with stress, if present. After this period the blood pressure should be checked again the same way as it was done the first time. If the blood pressure in over 140/90 but below 160/90 (such as in your case), non-drug methods should continue for another three months. If the blood pressure in persistently above 160/90, then drugs should be given. The first line drug should be an ACE inhibitor such as ramipril sold as Ramistar, Cardace, Cardiopril etc. Even though it starts acting within hours, the full effect is not noticeable for about two weeks. Hence it should be continued for at least two weeks. If the blood pressure does not fall, then amlodipine alone (such as Amlodac) 5mg once daily can replace ramipril. There is no clinical need to put a patient on two drugs without waiting for full effect. Beta-blockers (such as atenolol) should not be used because of the unacceptable risk of developing diabetes. The British National Institute of Clinical Excellence (NICE) has put beta-blockers at the 4th option to be used only when the first three options (amlodipine, ramipril, losartan and a diuretic) do not produce adequate results either alone or in combination.