Q: I am taking the following medications for high blood pressure - Atacand 800 once in the morning, Metolar 50 mg, Nicardia 10 mg. Please advise if these drugs are helpful? Will these drugs harm my kidneys? My blood pressure normally remains 140-130 (systolic) and 100-80 (diastolic) mm Hg.

A:You are currently taking three medicines for blood pressure i.e. Atacand (candesartan) 8 mg daily, Metolar (metoprolol) 50 mg twice daily and Nicardia (nifedipine) SR (slow release) 10 mg three daily. It is not clear as to why three drugs are being used at your age. Was an attempt made to control blood pressure with one or two medicines? 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 from 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 few patients, enalapril may give rise to cough. In such cases losartan (sold as Losacar) 50 mg once daily or candesartan (sold as Atacand, Candesar etc.) can be used. If two drugs are required, then enalapril (Enam) and amlodpine (sold as Amlodac) 5 mg in the morning should be used. In very few cases, it becomes essential to use three drugs. In such a situation, enalapril (Enam), amlodipine (Amlodac) and a diuretic such as metolazone (sold as Metoz) 2.5 mg in the morning should be used. A product such as metoprolol (Metolar) should not be used because it can precipitate diabetes apart from causing impotence in males. Atacand (candesartan) can also cause impotence. The ultimate objective is to use as few drugs as possible at such a young age to avoid both short term and long time side effects. In your case brisk walk daily to cover at least 4.5 km in 45 minutes will help to reduce drug intake and also reduce weight. You need to loose at least 5-7 kg. The very purpose of using Slow Release products (such as Nicardia - nifedipine- SR) is to reduce the frequency of dosing. I do not know why Nicardia SR is being given three times daily; normally it needs to be given just once or twice daily.