Q: I am 36 years old and weigh 80 Kgs. Of late I have developed high blood pressure. The lower pressure itself is 110 mm Hg. I consulted a doctor and was given Aten 50, Ramiphrill & eslo. It didn't help. Then the doctor gave Normace D which has reduced the blood pressure. Is it good to continue Normace D for along time? I find some constipation after taking this medicine. I have checked the Lipid profile and found that my cholesterol is a bit high. How can I reduce it?

A:Lately, there has been lot of research in the treatment of high blood pressure. As per globally accepted guidelines, patients below the age of 55 years should be initially prescribed a drug belonging to the ACE inhibitors group such as enalapril (sold under the brand name of BQL, Enam etc) starting at 5 mg daily and increasing gradually to 10 mg 1-2 times daily. Such drugs are best for sexually active males. If the response after three weeks is not adequate, then one of the following two drugs should be added: - a diuretic (that helps produce more urine and gets rid of salt) such as low-dose indapamide 1.5 mg (sold under the brand name of Indicontin Continus) in the morning OR - amlodipine 5mg (sold under the trade name of Amlodac etc.) once daily. Generally a two-drug regimen in young patients is adequate. Normace D is a fixed dose combination of two medicines: enalapril 10 mg and hydrochlorothiazide 25 mg. Hydrochlorothiazide is also a diuretic but its dose in high blood pressure should be no more than 12.5 mg. A dose higher than 12.5 mg does not produce any additional benefit but leads to unpleasant side effects such as weakness, male impotence, increased risk of diabetes and gout. In general, one should avoid the use of fixed-dose combinations. Please see general note below: 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. You will also need to reduce your body weight by about 10 kgs since you are over-weight and undertake mild exercise such as brisk walk for 45 minutes to cover no less than 4.5 km daily (at least 6 days a week). These measures will help reduce the dose of medicines and prevent the need to add more drugs in future. Also they will help reduce your cholesterol.