Brief Answer:
Add olmesartan to the regime. Do read the detailed answer.

Detailed Answer:
Hello XXXXXXX I am Dr. Mody and I will be addressing your concern.
Firstly as you have said that all work up was done as mentioned, so your doctor in most probability have ruled out secondary (reversible) causes of hypertension.
Now coming to the symptoms and nebistar.
Nebistar is a beta blocker, this group of medication causes some sexual dysfunction.
So now why did your doctor started it ?
Most probably as you had palpitations, Netanyahu blocker are one of the best medication to decrease palpitations and nebistar is the newer beta blocker which is heart selective and has doesn't cause much sexual dysfunction.
Now what I would recommend :
1) The pressure range you mentioned is considered stage 2 hypertension and so it would not be controlled with only one nebistar.
The reason you may still have higher reading
2) Major part of palipation and even sexual dysfunction may be due to higher blood pressure itself
3) Though I my practice I have seen a lot of my patients complaining of sexual dysfunction with nebistar, but stopping it suddenly will push the blood pressure further up.
So finally.
I would recommend you to start
Tab olmesartan (Olmezest ) 20mg at night and continue nebistar 5mg in morning
As soon as your blood pressure reading come to 120-130 upper and 80-85 lower we can start decreasing nebistar and supplement with other medication.
Also restricting salt in your diet to less than 3gm /day and if obese loosing weight is of utmost importance.
In the initial part we may need to set your medication by titration. Let me know your blood pressure reading 72 hours after starting the medication and would guide you further.
Lastly remember anxiety itself will have major effect on your sexual efficacy, so don't let it creep in your mind.
This will be the safest way forward rather than changing medication at a go.
Hoping I could help
You may directly connected with me in future on the website at ask a specialist http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
Regards Dr Priyank Mody,

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Brief Answer:
No smoking, moderation in alcohol

Detailed Answer:
Hello, surely smoking and alcohol both would push up your pulse and blood pressure because of the nicotine and like substance.
You are young to have these problems so quitting smoking is the only way out and you are still at an age when it's possible.
Now some palpitations may be due to quitting of smoking too, as the body's want of nicotine may make you cranky, push your blood pressure and pulse up. Easy tiredness, some psychological constipation , sweating. However all these are transient and will go off.
So ny recommendation.
STRICTLY, no smoking
Alcohol, try shifting to wine, red wine preffered or nvr more than 2 drinks (30ml) in a day.

I would suggest taking Sompraz D 1 tab 15 mins before breakfast, in an antacid, which you should take just 2 weeks as the symptoms you describe may be due to reflux gastritis which would increase with smoking and alcohol.
Let me know after a week how things are.
Regards Dr Priyank Mody

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Brief Answer:
Do go through the detailed reply. Regards

Detailed Answer:
Hello,
In most probability the incidence of those palpitations have increased as part of withdrawal reaction to nicotine. Yes alprazolam is a sedative for benzodiazepine group. The only significant side effect for you is the addictive potential, so don't get used to it, you can temporarily use it to tide over the crises but not more than 3 months and not everyday.
You can be free with your diet except less salt in all your food.
Second most important it to take adequate potassium, green leafy vegetables, nuts and fresh fruits are a rich source of potassium.
So atleast one sabji of green vegetables and 2 serving (bowl) of fruits in a day should be good.

Also there is something called organic salt, which contains potassium chloride instead of sodium chloride, which can be taken as salt substitute.

Lastly no free potassium supplements and only in food should be taken, as olmesartan is the medication which too may increase your potassium.
Regards Dr Priyank Mody

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