Question: My doctor has prescribed Coreg, mentioned in your recent report, along with Diovan for controlling my high blood pressure. I have been on this medication for about 5 years. I am a male age 83, and recently the doctor added Norvasc. Does this sound like a reasonable approach for controlling high blood pressure? I average 150/65 and sometimes as high as 150/90.

Dr. Hibberd's Answer:

The mixture your doctor has prescribed is usually well-tolerated, provided regular monitoring is provided and correct dosing is used. Coreg is a beta blocker medication with some favorable reports when used in patients with mild congestive heart failure. It is not to be used in decompensated heart failure, asthma or in patients with liver impairment.
Diovan is an angiotensin receptor blocker that is commonly used for blood pressure management along with periodic monitoring of renal function. NSAIDs (most non-Tylenol, anti-arthritic drugs that include over-the-counter pain relievers such as Advil, Aleve, etc.) impede the effect of Diovan and may cause reversible deterioration in renal (kidney) function. Despite this, Diovan is protective from further renal damage in diabetic patients, especially, and requires periodic monitoring of renal function and electrolytes.

Norvasc is a calcium channel blocker with quite a good record. Avoid grapefruit juice with this agent, as it will cause an enhanced effect. It is also not to be used in decompensated congestive heart failure.

There are less expensive alternatives (such as hydrochlorthiazide, a diuretic) that probably could be used to augment the blood pressure-lowering effect of your current medication, but this of course will depend upon your existing medical circumstance and co-existing medical conditions.

It is not at all unusual to require two or three agents to achieve good blood pressure control. Lower doses of multiple agents will often enable patients to avoid the side effects of using high doses of one agent alone, as well as an enhanced blood pressure (synergistic) response beyond the effect expected by using each medication alone. I usually favor low doses of multiple agents over high doses of a single agent.