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Do I need to change the medications for high blood pressure?

Q: I am a 41 years old man who was diagnosed with high blood pressure 4-5 years back. I also have a family history of high BP, although no heart disease/sugar problems are there. I was recommended Amcard 5 mg twice a day. My BP (through random checks) has been stable (130/90 mmHg) since then and ECGs also are normal. I recently met a cardiologist who has suggested that Amcard dosage be reduced to 5 mg daily and second dose be replaced by Cresar 40 or 80. Please advise on this change in drugs.

A:You have not given the blood pressure reading when initially you were prescribed medicines. Unlike in the distant past (some two decades ago), these days doctors are expected to depend on globally accepted guidelines in the treatment of hypertension rather than personal perception and individual experiences on a handful of patients. These guidelines are evidence based and written on the basis of global clinical trials involving thousands of cases. For mild high blood pressure (below 140/90 mmHg) detected initially, no drug treatment is required if there are no additional risk factors such as smoking, high lipid levels in the blood, diabetes, etc. Even when drug treatment is offered, the aim is to reduce it to 140/90 mmHg. Once this is achieved there is no further need to give additional medicines with all their side effects and no benefit in the long range. Two drugs are to be given only when one drug in its optimum dose does not achieve the targeted level. In sexually active male patients below the age of 55 years, the first option should be Enalapril (sold as Enam) 10 mg 1-2 times daily. If the blood pressure remains above 140 (systolic) and/or 90 (diastolic), then only a second drug needs to be given. For male patients below 55 years of age, the second drug, if at all needed, should be either Amlodipine (sold as Amlodac, Stamlo) or a diuretic (such as Metoz). In your case, since you are adequately controlled by Amlodipine 5 mg twice a day, there is no clinical need to review unless you have any sexual problems. In that case you will need to be put on Enalapril (Enam). One should keep in mind that more drugs not only lead to more action but more side effects!

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