Q: I am 43 years old and have a blood pressure (BP) problem for the last one year. I am using Nebicard-H daily in the morning from the last 3 months. Earlier my BP was 180/140, now it is 160/110. Yesterday the doctor again prescribed Telepres 40mg at night. Now I am taking Nebicard -H daily in the morning. Can I take Telepres Tab-40mg?
A:Nebicard-H is a combination product of two medicines: nebivolol and hydrochlorothiazide. In addition now you have been prescribed telmisartan (Telepres). Thus you have been advised to take three medicines for controlling blood pressure.
There has been lot of changes recently in the treatment of blood pressure, particularly in young sexually active males. The globally accepted guidelines are:
In patients younger than 55, first choice initial therapy should be an ACE inhibitor such as enalapril (sold under the trade name of BQL etc.) 5-10 mg 1-2 times daily.
In cases where two drugs are required, then add a calcium channel blocker such as amlodipine (sold under the trade name of Amlodac etc.) 5mg once daily or a slow release, low-dose, dual-action diuretic such as indapamide (sold under the trade name of Indicontin Continus) one tablet in the morning daily.
If treatment with three drugs is required, enalapril (BQL), amlodipine (Amlodac) and indapamide (Indocontin Continus) should be used.
Nebivolol and other similar beta-blockers are not recommended because they perform less well than other drugs and the increasing evidence that they carry an unacceptable risk of provoking diabetes apart from causing impotence in males.
It is also not a good idea to take combination products since the dose of individual agents cannot be titrated.