Expert: Eric Brandt - 8/24/2007

Question
Dear Doctor
I am 37 male Indian, non-smoker, fairly regular food and exercise habits.
I was diagnosed with Essential Hypertension of around 160-170/90-100 levels around 4 months ago.

I was initially given Losartan 25mg and after a week shifted to Losartan 50mg + Hydrochlorothiazide 12.5 one daily.

After 2 months of this dosage, average readings were around 145-150/85-90.

My physician felt these levels were still high and advised me to take Nebivolol, but since I had been reading a lot about lack of use of B Blockers these days, I consulted another doctor who advised me to add Amlodipine 2.5mg.
The readings fell to around 130/85 and my doctor felt it was fine.

Since I was uncomfortable with taking 3 drugs on my own, I cut down my medicine to Amlodipine 2.5mg and Losartan 25 mg only. After around 2 weeks on this reduced dosage, readings continued at near normal.

I have now tried to further cut out the Losartan and for the past 3 weeks am on Amlodipine 2.5mg alone. Current home readings are around 140/90 (a little higher and a little lower at times). Should I add either Losartan 25mg or maybe a diuretic to present Amlodipine 2.5mg.

I have a family history of diabetes (mother’s side) and would like to be careful in taking a medicine, which could later induce diabetes.

I am fed up with experimenting and would like to have a simple yet effective regime, which I can stick to.

Please advice me what combination I should go for.

Thanks


Answer
Hi Vijay,
Because there is`family history of diabetes and you may be at risk you should stay on some regimen which includes losartan. There is ample evidence that losartan can protect the kidneys from damage usually caused by diabetes. If the dose of losartan is insufficient to control the blood pressure then amlodipine can be added. The mlodipine dose you are on is quite small and there is room to increse the dose to achieve more optimal blood pressure control. You should report toy your doctor your observationswith experimenting with the drugs and dosages and together you can come up with an effective and acceptable drug regimen.
Thank you for using Allexperts
Sincerely,
Eric Brandt, B.Sc. Pharm