### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am taking amlodipine since Sept 9 this year but recently my blood pressure is elevated. I had hip surgery in August but BP was okay but recently spiked various time of the day and I am doing 4 readings since I had low sodium level but fine now. I am alarmed about the high BP i.e. 173/92 or 176/110. Yet other times it will 144/94 or 155/89. What causes this as I did not have issues when I was on Verapamil for several years. I was switched to amlodipine cause it did not affect my heart rate. I always had low heart rate but was told the new medication does not affect the heart rate. Advise why a spike in BP? I advised my doctor but haven t heard back yet

### output:

Hello Thanks for posting here. I have gone through your description. Your BP seems to be persistently higher despite taking amlodipine daily. Verapamil is a stronger blood control medication than amlodipine. But one of its effects is lowering the heart rate, which in your case was lowered too much hence stopped. The amlodipine you are taking is not enough to control your BP and hence it must be changed. If you were my patient, I would start you on tablet Selma AM which is a combination of telmisartan plus amlodipine which would be an ideal combination for you. It does not lower the heart rate and has beneficial effects on the kidney and heart. The brand name Selma AM may change from country to country, but telmisartan 40 mg plus amlodipine 5 mg combinations are available worldwide. You can take one tablet of Selma AM. It will definitely help get your pressure under control. If despite this your blood pressure remains high (after two weeks of starting Selma AM) you must undergo a 24-hour ambulatory BP monitoring which records your BP every 15-20 mins while you go around your daily routine activities. It gives us an idea of your pressure control, effect of medications, time of day when pressure is high, and also we can correlate high blood pressure with the activity you were doing at that time. So to proceed further, please take the telmisartan amlodipine combination I have advice for two weeks and then follow up. Wishing you good health. Regards