How does one treat hypertension?
Q: Recently a doctor suggested me the following medicines ASA-Delayed action Aspirin 5mg -everyday-life time. Amixide-H for three months, one after dinner. Raciper-D one capsule before breakfast for two weeks. I took the above 2 medicines for 20 days. The third one for two weeks. Now I have stopped all the three medicines as I read that Amixide is not approved in advanced countries. A psychiatrist can prescribe them only. Will there be any complications since I have taken it to reduce my blood pressure, which was 170/90. I don't have diabetes. My cholesterol is 217. I have gas problem as well. Can I take homeopathic medicines?
A:There has been lot of progress in understanding and treating high blood pressure in the last few years. Research both in the United States and United Kingdom has established that in elderly patient the first drug of choice for controlling blood pressure should invariably be a diuretic - a medicine that increases urine output, reduces volume, decreases pressure on heart and saves the irritating botheration of cutting on salt intake. Hence we start with a dual action diuretic-cum antihypertensive agent such as slow release indapamide (Indicontin Continus) 1.5mg one tablet in the morning. If the blood pressure is not controlled with a single medicine, then another medicine belonging to another group such as captopril (Aceten) is added. Since you are already on two drugs you may require two medicines i.e. Aceten and Indicontin Continus. On the first day when Indicontin Continus is taken, Aceten should not be taken; however 2nd day onwards both medicines can be taken. This is to avoid sudden drop of BP. Myogard is the brand name of a medicine called nifedipine. We no longer use plain nifedipine for controlling blood pressure. When ever this medicine is to be used its slow-release formulation is administered. There have been some unfortunate cases where plain nifedipine has led to sudden drop in BP, even syncope. Unfortunately both Myogard (nifedipine) and Aceten (captopril) can cause stomach upset. Furthermore Myogard is a dilator of blood vessels and hence can give rise to the feeling of hot skin and perspiration. This happens more frequently when plain nifedipine (Myogard) is taken. There is very good reason for you to take aspirin 50mg a day even though it sometimes causes gastric irritation. But its advantages are many. There appears to be hardly any justification in administering an anti-psychotic fixed-dose combination of amitriptyline + chlordiazepoxide (Amixide-H). Such a combination is not permitted in any advanced country because it is irrational. Besides there is no history of depression in your case, a disease best left to psychiatrists to handle. Raciper-D is again a fixed-dose irrational combination of two medicines: esomeprazole and domperidone. Due to lax laws such irrational products are being produced and heavily promoted to the medical profession. Please see general statement on the Fixed-Dose Combinations below. One result of using combination products is that at one stage you were taking 8 medicines! Unfortunately India is at the top in consuming nutritional, vitamin supplements. These are only required when there is documented, proven deficiency. You may wish to review if you require Centrum. Overvitaminosis is a known problem. Fixed-Dose Combinations (FDCs): Medicines are discovered individually and are supposed to be taken separately. A huge number of irrational, illegal combinations of drugs are being sold in India; quite a few without mandatory approval of the Drugs Controller General, India (DCGI). Except in a few cases (such as TB medicines), it is always better to take medicines separately so that dosage can be adjusted and side effects monitored.