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Is a multi-drug approach to treat hypertension essential?

Q: I am suffering from hypertension since the last 4-5 years (my BP has never gone beyond 150-100) and currently I take the following medicines: Amlodac 5 mg, Coversyl plus and Nabicard 5 mg. Actually, Amlodac has been added quite recently (since my BP was not coming under control) and since it is well under control. As Amlodac has shown positive results, is there any need for other medicines? My cardiologist is insisting on taking all the drugs but many of my colleagues say that just one tablet is enough. Please advise.

A:Currently you are taking four medicines for high blood pressure: Amlodipine (Amlodac), Perindopril + Indapamide in one pill (Coversyl Plus) and Nebivolol (Nebicard). The best way to control blood pressure is by combining life-style changes (diet, exercise involving very brisk walk of at least 4.5 km in no more than 45 minutes daily) with the minimum dose of minimal medicines on a Step Up approach basis i.e. add 2nd or 3rd drug only when there is inadequate response. Care has also to be taken to avoid the use of certain drugs to sexually active males. In a case like yours, one should start with Amlodac 5 mg daily (maximum: 10 mg daily) along with a slow-release anti-hypertensive diuretic Indicontin Continus 1.5 mg in the morning. If the response after say 2-3 weeks is not adequate, enalapril (BQL or Enam) 10 mg once daily (maximum 20 mg in two divided doses) can be added. In very rare cases it is necessary to add further medicines. If possible drugs belonging to beta blockers group such as Nebicard (nebivolol) should be avoided in relatively young males.

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