Q: My 39 years old wife is suffering from hypertension and rheumatoid arthritis for the last 3 years. She is taking Lefumide 20 mg, Folitrax 15 mg, Etrobax 90 mg, Fefol-z and Shelcal daily; and, Tenormin 50 mg daily for high blood pressurebut with no reliefain. Can she switch over to Telma-H? Please advise.

A:One of the causes of uncontrollable high blood pressure is obesity. For a height of 5.3 ft, the patient is certainly over-weight; hence every attempt should be made to lower the weight. Tenormin (atenolol) is not a good choice anyway since it can precipitate diabetes. The patient can be put on enalapril (sold as Enam) 5-10 mg 1-2 times daily as per response. If the blood pressure does not come down, then second medicine such as amlodipine (sold as Amlodac) 5 mg in the morning can be added. Alternatively, a diuretic such as metolazone (sold as Metoz) 2.5 mg in the morning can be prescribed. There is always a clinical challenge when so many medicines are administered concurrently due to side effects and interactions between various medicines.