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How should I manage my hypertension and urological problems?

Q: I am suffering from hypertension and am on Amlopress 5 mg (morning) and Ibesartan 150 (Irovel)in the evening. Is Amlopress a diuretic? If so, shall I switch over to Irovel H once a day. Will it overcome the need for two tablets? I was found to have multple calculii in both kidneys and my ultrasound of the bladder suggested that I had post void bladder volume of 87 ccs. The prostrate was mildly enlarged measuring 3.6 x 3.9 x 3.8 and weighs 27 grams. What is the normal weight and normal post voidal urine? How do I tackle the multiple calcuii and prostate problem? Is it a cause for concern? I wish to take Himplasia (Himalaya Drug) for prostrate but should I check with the doctor if hypertensive or people on diuretics can take Himplasia?

A:There have been lot of changes in the appropriate treatment for hypertension in the past few years. Weight control, low fat diet and exercise (brisk walk for at least 45 minutes daily to cover no less than 4.5 km) are as important, if not more, than medicines. In your case for a height of 5 7 you need to substantially reduce your weight to around 66-67 kg. Otherwise more and more medicines in higher and higher doses will be required that will produce many side effects. At your age, the first line treatment should be a specific anti-hypertensive diuretic such as indapamide (Indicontin Continus 1.5mg) one tablet daily in the morning. If this alone does not bring down the blood pressure to normal levels in 2-3 weeks time, one can add an ACE inhibitor such as enalapril (sold under brand names like BQL, Enam etc) 10-20mg daily or a calcium chanell blocker such as amlodipine (Amlodac) 5mg daily. In most cases these will suffice. In cases that do not respond to two medicines (i.e. a diuretic + enalapril or amlodipine), it may become necessary to add a third agent i.e. ARBS (losartan or candesartan or irbesartan or telmisartan - they are more or less alike). Fixed-Dose Combinations (FDCs) of two or more medicnes should be avoided. 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. There is no cause for concern with regard to your prostate. Your values are quite acceptable. For renal stones you should consult a urologist. There is no medicine that dissolve the stones. Please keep in mind that stones can impair kidney function and lead to deterioration in blood pressure. There is no scientifically proven efficacy and safety profile of Himplasia. Besides there are grave concerns on the safety profile of many Ayurvedic products due to their high heavy metal contents such as lead, arsenic, mercury etc. Many such products have been banned in US and UK.

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