Q: I had been suffering from hypertension and back-pain for more than five years. For this I had been taking one Amlopress AT tablet per day regularly. My weight was 80 kg (and my height is 5.11). When I checked my blood cholesterol, it was found to be 270. As the cholesterol level was high, as per the advice of the doctor, I reduced my food intake and started morning walks for 15 minutes. I also reduced my salt intake. Within two months, my weight has come down from 80 kg to 73 kg. Now, I have started feeling better and not experiencing back-pain. But, at the same time, my BP has come down from 140-90 to 100-60. I have been experiencing blockage of left nose for the last few years. Besides, I have been experiencing sleeplessness in the night. As per the advice of the doctor, I have reduced my medicine Amlopress AT from one to half. Still my BP is lower ie 100-66. Incidentally, I am a Haemophiliac (factor VIII deficiency 9%). Please advice whether I need to take more food, stop morning walk and altogether stop my medicine so as to attain the normal BP level.

A:You are doing fine by producing a good health-exercise programme. Please keep it up. The weight loss and the improvement in your blood pressure are both as one would expect. The most important question that needs answering is whether you have sustained hypertension that needs treatment, and if so what is the cause of the raised blood pressure. You did not mention whether you have any family history of high blood pressure. Most patients with hypertension tend to have the same problem in one of their blood relatives. In young patients with hypertension and without any family history, there may be some other cause that needs to be investigated. I think the next step you should take is to get your doctor to stop your Amlopress and watch your blood pressure for a couple of weeks. If the facilities for monitoring 24-hour blood pressure exist then you should have your blood pressure monitored for 24 hours to see if it goes up during any activity or periods of stress. If the blood pressure remains low then you don't need any treatment, but you should have it checked regularly, say every two or three weeks. If the blood pressure goes up while you are off Amlopress then you should start it again at a lower dose to get a tighter control of your hypertension.