Q: My mother is 53 years old. She suffers from rheumatoid arthritis. Her blood pressure (BP) has been borderline for the past 5 months and now she has been confirmed as hypertensive. Her BP reading was ranging between 176/104 to 156/94 and she was prescribed Tenormin 50 mg (Atenolol), which lowered her blood pressure but it lowered her pulse rate as well. The pulse rate was ranging between 47 to 52. The doctor prescribed Losartan alongside the same dose of Tenormin. He has now prescribed Stanlo (Amlong) 2.5 mg. I am very anxious about her health because she had to contend with wrong medication due to which her arthritis problem began. I don't understand why she has been prescribed two medicines. In all BP patient cases, I have studied that they need only one medication. My mother is already having too many pills for arthritis and this is adding to her stress and depression.

A:Good clinical practice demands that initially only one medicine should be used to control blood pressure. Only when in full dose the medicine does not achieve BP control should another drug be added. This is even more important in elderly patients who may already be taking other drugs for other diseases. Atenolol and other beta blockers (such as propranolol, metoprolol and other 'lols') do lower pulse rate. It is not wise to allow the pulse to go below 55 at the most. There is no scientific logic in giving two drugs when one can control the BP. Also, losartan will not help in correcting the pulse not to mention the fact that giving a second drug merely to counteract the adverse effect of the first is not good clinical practice. It will increase side effects and may interact with other medicines being consumed. There is now international consensus that in controlling the BP, the initial drug of choice (particularly in elderly) should be a diuretic (a medicine that increases urine production and thus lowers the blood pressure). Apart from lowering BP, a diuretic obviates the need to have strict control on salt intake (so that patients can eat normal food with normal salt). Slow-release indapamide (Indicontin Continus) 1.5mg daily in the morning is generally adequate to control BP. Only when this therapy does not bring down the BP in about 10 days time, should one ever think of adding second medicine. Even when second medicine is added, the diuretic should continue to be taken.