Dear Dr. Roach: I’m a 69-year-old woman who’s been on different blood pressure medications for a very long time. I was on 20 mg of lisinopril and 5 mg of amlodipine for a while, but my blood pressure spiked to 190/100 mm Hg. My doctor then increased the amlodipine to 10 mg, which brought my blood pressure down somewhat, but I still was often in the 150-170 range.

I also had a fast heart rate often, so metoprolol (50 mg) was substituted for amlodipine. This didn’t really work, so 12.5 mg of hydrochlorothiazide (HCTZ) was added. Now I’m suddenly having low blood pressure — the average being about 104/63 mm Hg but sometimes as low as 91/55 mm Hg.

Do you have any suggestions as to how to manage this balancing act? Should I be concerned about my blood pressure being this low? I have no dizziness or other symptoms. — D.H.

Answer: Even though you aren’t having any symptoms, this isn’t ideal blood pressure treatment. Most people in their 60s and 70s should have a treated systolic blood pressure that averages in the 120s. People who are at a high risk for heart disease or strokes should have a systolic blood pressure that is less than 120 mm Hg.

It seems that HCTZ really worked for you, even at the lowest dose, when it was added to the lisinopril and metoprolol. If you were my patient, I would probably lower the lisinopril down to 10 mg and see if this gets you into the ideal blood pressure range. Lisinopril can also be dosed at 5 and 2.5 mg.

I find, and most experts agree, that a combination of blood pressure medicines at low or medium doses is more effective and has fewer side effects than one blood pressure medicine at the highest dose. There are combination tablets (such as lisinopril with HCTZ) to make it easier to take the medication.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.