Q: My 36 years old husband has been suffering from hypertension for the last five years. He takes Cardace (5 mg) and Presolor (a combination of atenolol and nifedipne) one each daily. He used to take Homeopathy medicine on regular basis but has discontinued it because of ineffective results. What drugs shall he take to reduce his blood pressure?

A:There are internationally accepted standard therapeutic guidelines on the treatment of younger (under 55 years) patients with high blood pressure. Most patients need one or at the most two medicines. The first line therapy is enalapril (such as Enam) or ramipril (such as Cardace, Cardiopril, Sclerace; Cardace brand is far more expensive with no benefit). If the blood pressure is not controlled with ramipril 10 mg daily, then a second drug may need to be added. It can be either nifedipine (sold as Depin Retard) 10-20 mg daily or losartan (sold as Lozitan) 25-50 mg once daily. In the most unlikely event of two drugs not being fully effective, then the 3rd drug should invariably be a diuretic such as metolazone (sold as Metoz) 2.5 mg daily. Atenolol either alone or in combination is not recommended because it can precipitate diabetes. Also in many males, it can cause sexual dysfunction. Needless to say that non-drug management is also essential i.e. less salt, low fat diet, mild exercise (such as brisk walk for 45 minutes daily to cover no less than 4.5 km), no smoking etc.