Q: I am a 27 years old man having hypertension for the last 1.6 years. After brief episodes with calcium channel blockers and beta-blockers, I am currently taking Telma -H. Of late, my uric acid level has increased. I do not know if it is due to the diuretic? I take Diuretic 25 mg per day. For some reason, the doctors have not prescribed me any ACE-inhibitors; please let me know if that would be a better choice? I neither drink nor smoke, and the last tests revealed that I have no kidney or heart problems.

A:In sexually active males under the age of 55 years, the first option in the treatment of high blood pressure should be an ACE-inhibitor such as enalapril (sold as Enam) 5-10mg 1-2 times daily. A second drug should be added only when life style changes (brisk walks, low salt/fat diet etc) do not bring down the blood pressure to 140/90 mm of Hg or below. Hydrochlorothiazide (one of the ingredients of Telma-H) is known to increase uric acid levels and hence should be discontinued. Moreover, a dose beyond 12.5mg of hydrochlorothiazide per day is not more effective in hypertension but causes more side effects and hence is not needed. One should always take medicines individually rather than as Fixed-Dose Combinations of two or more medicines since dose of individual ingredients cannot be titrated.