Q: I have hypertension and I was on Asomex-AT and later changed to Asomex-5 twice a day. I have started brisk walks for an hour recently. Now, I have developed scalp psoriasis for which my dermatologist has asked me to stop Amilodipine. If I take Losacar-50 mg can it be taken one in the morning and one at night (100 mg per day)? Using Asomex-5 twice a day my BP was somewhere between 140/100 mm Hg but not beyond that or lower than that. My lipid levels are normal and I have a family history of hypertension and I am also obese. Now I am worried about psoriasis too but for that I use Exorex and Diprovate-S. Please advise me regarding the medicines?

A:Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk. Metabolic syndrome is a significant predictor of cardiovascular events. Various health organizations have proposed different guidelines to define metabolic syndrome. These definitions are overlapping and include the clustering of cardio-metabolic risk factors of obesity, insulin resistance, elevated fasting glucose levels, impaired glucose tolerance, or type 2 diabetes, together with dyslipidaemia and hypertension in the same individual. Metabolic syndrome is significantly more common in psoriatic patients. Psoriatic patients also have a higher prevalence of hypertriglyceridaemia and abdominal obesity, whereas hyperglycaemia, arterial hypertension and high-density lipoprotein cholesterol plasma levels were similar. Although psoriasis patients also are more frequently smokers, the association of psoriasis with metabolic syndrome was independent from smoking. There is no correlation between severity of psoriasis and prevalence of metabolic syndrome. Psoriatic patients with metabolic syndrome are older and have a longer disease duration compared with psoriatic patients without metabolic syndrome. Since psoriatic patients have a higher prevalence of metabolic syndrome, which can favour cardiovascular events, I suggest you should correct aggressively the modifiable cardiovascular risk factors. Low fats and low calorie diet, regular workouts, abstinence from alcohol are compulsory. Please consult your physician and request for anti-hypertensives that do not contain beta-blockers and ACE –inhibitors. Aspirin must strictly be avoided. For your psoriasis, use abundant emollients like liquid paraffin. Use an anti-histaminic for the itching. Please see your dermatologist.