Q: I am a 34 years old woman having high blood pressure in the range of 140/90 mmHg since I conceived 7 years back. My weight is 62 kg and height is 151 cm. Earlier I was taking Losartan Potassium and Hydrochlorothiazide (Vasortan-H) and my BP went down to 130/82 mmHg. Now, the doctor has recommended using Telmisartan 40 mg because Losartan is not so effective. Is it advisable to use Telmisartan? I take Nicardia retard 10 mg twice a day too. Please advise.

A:Drug treatment is not started when the blood pressure in 140/90 mmHg. It is a borderline case and should be managed with diet, salt restriction and mild exercise along with a little bit weight reduction. Hence I do not know the reasons for putting you on three drugs to control blood pressure. I think your case and therapy should be reviewed. Losartan and Telmisartan (both being sartans) belong to the same class and same group of medicines having the same mode of action. If a person is not responding to Losartan, then chances of responding to Telmisartan are virtually very little. Moreover, replacing Losartan + hyrdrochlorothiazide with just Telmisartan is most unlikely to control the blood pressure since Hydrochlorothiazide (a diuretic) has a very important role in reducing blood pressure and getting rid of excess salt. There was a time several decades ago when individual doctors were prescribing medicines based on their personal, essentially limited, experience. Now there are internationally accepted guidelines on the treatment of blood pressure in various age groups provided the reading is above 140/90 mmHg (and there are additional risk factors such as diabetes, high cholesterol levels, etc.) or 160/100 mmHg (even if there are no additional risk factors). In patients younger than 55, first choice initial therapy should be Enalapril (sold as Enam) 5-10 mg 1-2 times daily. In cases where Enalapril produces side effect such as persistent, dry cough (in about 15-20% of the cases), then Losartan (or Valsartan or Telmisartan or Candesartan or Olmesartan or Irbesartan) can be used. If two drugs are required, then add Amlodipine (sold as Amlodac) or Nifedipine (sold as Depen Retard, Nicardia Retard) 10-20 mg 1-2 times a day. For patients if treatment with three drugs is required, then Enalapril (or one of the sartans), Amlodipine or Nifedipine and a diuretic such as Metolazone (sold as Metoz) 2.5 mg in the morning should be used.