Q: I have been on medication for hypertension for the last 15 years. I take Amlopin 5 mg (Amlodipine) with Ecospirin-75. My BP is under control, but I get swelling at the ankles by the end of the day. It is not very noticeable or inconvenient. It disappears by the time I wake up in the morning. I am told that with Amlopin, a diuretic is a must. Is it so? If so, what would be the right dose?

A:In the past 2-3 years lots of changes have taken place in the treatment of high blood pressure. Currently, as per globally accepted evidence-based guidelines, patients above 55 years of age should be given a diuretic such as low dose, long acting indapamide (trade name: Indicontin Continus) 1.5 mg daily in the morning. One of the side effects of amlodipine is swelling of lower legs and/or feet. It is quite likely that your blood pressure will be controlled by just one medicine i.e. Indicontin Continus. If not, then enalapril (sold under the brand name of BQL) can be added initially at 2.5 mg daily; increased to 5 mg-10 mg daily, if required. Aspirin is indicated only if there is concomitant angina. Recent research based on use in 95,000 patients has established that in hypertensive males, aspirin increases the risk of haemorrhagic stroke by 69 per cent. Hence, it may not be taken routinely.