Expert: Dr Alan Galbraith - 9/29/2009

Question
Sir,
I am from India.
I have been diagnosed with Essential hyper Tension . My BP used to be between 160 & 100-110. I m currently 31 years of age.
Doctors advised me to go for complete heart package that included, Lipid profile, 2D ECHO,ECG Kritinine etc.
Though the reports were normal but it showed mild left ventricle hyper trophy. Doctor put me to Sartel ( Telmisartan 40 mg) & told me to come for review after three weeks.Even after taking the drugs to 3 weeks my BP were hovering around 140/100. So he gave me Telmisartan in combination with Amlodipin.
I am not getting the proper sleep. Can it be because of Side effect? Pl help me out. I will be highly oblidged.
Thanx  

Answer
Dear Animesh

Both of these drugs can cause insomnia, especially the telmisartan but rare with amlodipine). I would advise a complete rethink of your drug regime (after another week as it may take 4 weeks for full benefit) by your prescriber in view of the fact that your BP is still a bit too high.  I prefer drugs like telmisartan to be administered with a a diuretic called hydrochlorothiazide (HCT). I am sure that both are available in a combined tablet in India. A change to another sartan such as candesartan may be better as it is less associated with insomnia. Maybe 16mg (equivalent to 80mg telmisartan)with the HCT would be best. The amlodipine can be kept the same  but you do not say the dose 5 or 10mg. See how you get on but remember there are multiple options in the treatment of hypertension.

Get back to me and tell me how you are faring.

Regards

Dr Alan Galbraith