Q: I am a 39 years old man having high blood pressure. I am under stress for the last month. My blood pressure is 140/94 mmHg but my ECG report was normal. The doctor prescribed metoprolol succinate and hydrochlorothiazide (Starpress-H 50 XL). I also have a problem of irregular bowel movement for which I am taking Levosulpiride (Levazeo 25) and Rifaximin 200 mg (Rifagut) for the last month and then the doctor prescribed Alprazolam. I am afraid of the side effects of the tablets for high blood pressure. Am I taking correct medication? Please advise.

A:I am not sure if you are really a patient of high blood pressure needing any medicine. As per internationally accepted guidelines for the diagnosis and treatment of high blood pressure, a reading of 140/90 mm Hg or slightly more does not require any drug treatment except life style changes to cut down on salt, undertake mild exercise, refrain from smoking, reduce alcohol intake, reduce weight (if over weight), avoid fatty food (so that cholesterol remains within normal range) and manage stress by non-drug methods such as Yoga. If the reading is over 140 (systolic) and 90 (diastolic), then blood pressure should be measured again at a minimum of two clinic visits at least 30 days apart. If the pressure is still high, one should see if there are other risk factors such as diabetes, high lipid levels, family history of heart disease. If not, then no drug treatment is required apart from life style advice. Such patients should be reassessed after a year. Drug treatment is required if there are other risk factors or BP is over 160/100 mm Hg. If at all drugs are required, the first choice in young, sexually active male patients should be enalapril (sold as Enam) 5-10mg 1-3 times daily. Metoprolol is to be avoided because it can precipitate diabetes and cause impotence. Hydrochlorothiazide is never to be given initially and is to be used if one drug is not effective after three weeks of treatment. Alprazolam is an addicting drug with many side effects. It should never be taken for prolonged periods and if at all required, it should be used for a few days (less than week).