SudaMediCa, The Sudanese Medical Community

hi every one ....just wondering if someone give me consultation .. i has a patient with HTN and DM he also had stroke before ..any how he is on Lisinopril 10 mg BID and amilodpine 10 mg OD and daonil OD and glucophage OD... now his BP is 160/90 ..
according to last NICE guidlines we should offer him Thiazide but i concern about his blood glucose ?!? what can i add to control his BP ?!?
NB: his blood sugar are control to the normal limit !!!

Dr Mohammed what about increasing the dose of lisinopril to 20 mg ( some literature may allow 40 mg ) if cough is a problem change it to losartan ,I think if the blood pressure doesnt controlled after the maximum dose of losartan you should go for a thiazide-like diuretic, such as chlortalidoneor indapamide in preference to a thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide it may become a little bit harder to control the blood sugar.but it may not happen at all ,another important point is to make sure that his or her renal function is normal other wise you should stop dounil and start insulin .