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What is the ideal line of treatment for high BP?

Answered by: Dr Chandra M Gulhati | Editor, MIMS,
New Delhi

Q: I am taking Atenolol 100 for the last 5 years with no problems. Recently my diastolic pressure shot up and I added Amlopress to my daily dose. But it still goes high in the afternoon. I think it is due to my nervousness. Can I use Amlopress instead of Atenolol?

A:In the past 2-3 years, in the light of worldwide experience, evidence and data, the treatment of high blood pressure has undergone major changes. The current 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 - 5-10mg 1-2 times daily). If two drugs are required, then add a diuretic such as indapamide (sold under the trade name of Indicontin Continus - one tablet in the morning daily).

In patients aged 55 and over, first choice of initial therapy should be either a calcium channel blocker such as amlodipine (Amlodac 5mg daily) or a diuretic such as indapamide (Indicontin Continus). If a second drug is required, add an ACE inhibitor such as enalapril (BQL).

Beta-blockers such as atenolol are not recommended because they perform less well than other drugs, particularly in the elderly, and the increasing evidence that they carry an unacceptable risk of provoking diabetes.