What should I do about my uncontrolled hypertension (high blood pressure) while taking Coveram (perindopril/amlodipine) 10/5?

Management of Uncontrolled Hypertension with BP 170/120 mmHg on Coveram 10/5

Your blood pressure of 170/120 mmHg while taking Coveram 10/5 is dangerously high and requires immediate intensification of your antihypertensive therapy.

Current Situation Assessment

Your current blood pressure of 170/120 mmHg indicates:

• Severely uncontrolled hypertension despite being on combination therapy
• Increased risk of cardiovascular events, stroke, and organ damage
• Need for urgent medication adjustment

Immediate Steps

1. Contact your healthcare provider immediately - Blood pressure readings >180/120 mmHg are considered a hypertensive urgency requiring prompt medical attention
2. Continue taking your current medication - Do not stop Coveram 10/5 while awaiting medical consultation
3. Monitor your blood pressure - Check readings twice daily if possible

Treatment Intensification Strategy

According to the 2020 International Society of Hypertension guidelines 1, your treatment should be intensified following this algorithm:

1. Add a thiazide/thiazide-like diuretic to your current regimen

   • You are already on an ACE inhibitor (perindopril) and calcium channel blocker (amlodipine) combination
   • The next step is to add a thiazide-like diuretic such as indapamide or chlorthalidone

2. If triple therapy fails to control blood pressure:

   • Add spironolactone (25-50 mg daily)
   • If spironolactone is not tolerated, alternatives include eplerenone, doxazosin, or a beta-blocker 1

Medication Considerations

• Coveram 10/5 contains maximum dose of perindopril (10 mg) but not maximum dose of amlodipine (which can go up to 10 mg) 2, 3
• Your doctor may consider:
  • Increasing amlodipine component to 10 mg
  • Adding a thiazide-like diuretic as a separate pill
  • Switching to a triple single-pill combination like perindopril/indapamide/amlodipine 4, 5

Target Blood Pressure

• The target is to reduce your BP by at least 20/10 mmHg initially 1
• Ultimate target should be <130/80 mmHg 1
• Your doctor should monitor your response within 3 months to ensure adequate control

Lifestyle Modifications

While medication adjustment is essential, implement these lifestyle changes:

• Reduce sodium intake (<1500 mg/day)
• Adopt DASH diet (rich in fruits, vegetables, whole grains, low-fat dairy)
• Regular aerobic exercise (≥150 min/week of moderate intensity)
• Weight management (target BMI 20-25 kg/m²)
• Limit alcohol consumption
• Smoking cessation if applicable

Important Cautions

• Medication adherence is critical - Take medications exactly as prescribed
• Fixed-dose combinations like Coveram improve adherence compared to taking separate pills 6, 7
• Blood pressure monitoring should continue after medication changes to ensure adequate response
• Follow-up with your healthcare provider within 1-2 weeks after medication changes

When to Seek Emergency Care

Seek immediate emergency care if you experience:

• Severe headache with vision changes
• Chest pain or shortness of breath
• Neurological symptoms (confusion, weakness on one side)
• Blood pressure readings >180/120 mmHg with symptoms

Your current blood pressure level requires urgent medical attention to prevent complications and reduce cardiovascular risk.