My wife is 56 year old, she was taking TELMA - AM for the last 5-6 years to control BP and was okay and controlled. 6 months back her BP reduce to 110/70, her regular physician advise to Take TELMA-20, the BP is controlled but some time reduce to 110/70. Do we stop the medicine gradually? please advise.

Ans: Hello. If the BP is controlled but not low, it likely means it is controlled because of the medicine. To be able to control the BP without the medicines, you will need to make lifestyle changes to reduce salt, reduce weight (if high), improve sleep, increase exercise and reduce stress. If these are done side by side, you may see your BP coming a bit lower than normal and that is a sign that you can reduce your medicines.
Changing the medicine is only needed if you are experiencing any side effects from it. For eg, Telpress 40 AM has 2 molecules, telmisartan and amlodipine. Telmisartan can cause increase in potassium and needs to be stopped when you have fever or diarrhea/ dehydration to prevent kidney damage. Amlodipine can cause swelling in the feet. However if tolerated well, these can be taken for life without any problems. All the best.

Ans: Shishir,
Your age and other comorbidities/health issues you may have are not clear to me. How much you weigh and your height etc are not known).
However, please remember that anti-hypertensive medications are always supportive to lifestyle modification. Please do following:
1. Get a comprehensive blood test done which should include lipid profile, kidney function test and thyroid profile etc.
2. Ensure your weight is within normal range: for male, ideal weight is height in cm- 100 . for example, if you are 170 cm then your weight should be 170-100 or 70 kg. Thus enusre you have weight in normal range.
3. Do lifestyle modifications. eat healthy- fruits and vegetables, reduce salt in diet and walk at least 30 min per day for atleast 5 days a week. No more than 2 days of break.
4. Monitor BP twice in a day and prepare a chart for 10 days.

Based upon this information, a personalised lifestyle modification can be done.

With this information, and for your routine check up, visit your physician on regular basis.

Ans: BP medications should be judiciously used after good evaluation. Once started it should be followed up with Physician if there is a need to reduce the dosage

Ans: Yes, you definitely another medicine added to Telmisarten. If it is still not controlled, the dose of Telmisarten could be doubled and other medicine could continue in half strength.
It has been found that combination medicines in less than full strength are better than higher dose of single medicine.

Dr Chandrakant Lahariya
Centre for Health: The Specialty practice
Safdarjung Enclave, New Delhi