Q: My 41-year-old sister was diagnosed to have mitral valve prolapse with hypertension. Height: 148 cms; weight 59.3kg; haemoglobin 11g/dl; lipid profile within normal limits; normal blood sugar and no thyroid problem. Family history is positive for IHD and hypertension. X-ray chest was normal. She is on betaloc 50 mg twice (morning-evening) plus Ramipril 2.5. Due to chest discomfort, she underwent TMT which was positive and to rule out CAD, CAG was done which was absolutely normal. 2D echo doppler findings were: MVP ++, No I/C clot, LVEF 71%. BP recorded was 144/92. Cardiologist suggested a change in BP medicine and prescribed Losacar H 1/2 in place of Ramipril 2.5. Recently doctor has suggested drugs as under: Coversyl 2mg once, Betaloc 50mg. The doctor says that results of Coversyl are better and hence advised to switch over from Losar H 1/2 once to Coversyl 2 mg once. Is Coversyl a better drug than Losar H half once a day?

A:In order to reduce pressure on heart, it would be better to reduce the patients weight to around 48kg which is the average weight for an Indian female with a height of 148cm. One vital information is missing from your enquiry: the size of the heart. In many cases of MVP, the heart may get enlarged and affect the medication. Ramipril belongs to a group of medicines called ACE inhibitors. Coversyl is the brand name of a medicine called perindopril. Like ramipril, it is also an ACE inhibitor. There is hardly any difference between various members of ACE inhibitors; hence switiching from one ACE inhibitor to another is not very helpful. If a patient is not responding to ramipril, there would be hardly any response to perindopril. Betaloc is the brand name of a medicine called metoprolol. It belongs to a group of medicines called beta-blockers. They (except carvedilol) are usually not given in any disorder that can lead to the so-called heart failure or left ventricular failure (MVP can lead to this problem), particularly if the heart is enlarged. Losacar-H is the brand name. It contains two medicines: losartan (a member of the group of medicines called angiotensin II receptor blockers; indicated for use in high BP and reduction of stroke risk in high BP patients with enlarged heart) and hydrochlorthiazide (a diuretic - a medicine that increases urine production, is helpful in flushing out salt, reduces pressure on heart and brings down blood pressure). The latest research both in Britain and USA has proved that a diuretic must be given to all BP patients, particularly when they are taking more than one anti-BP medication. Changing medications frequently is to be avoided, leads to tolerance and is not worthwhile unless there are very strong reasons to do so. Based on information provided by you, I think Losacar-H is good and appropriate for the patient.