A 50-year-old type 2 diabetic male with HBP and dry eye disease and diabetic retinopathy. Medicines: 100 units of slow Insulin, Valsartan 320 mg, Amlodipine 10 mg, Escitalopram 10 mg, Xiidra eye drops. After years of high HbA1c of around 10.5 % last year has averaged around 6.5 %. BP runs around 150/105 mmHg.
I have managed to radically improve glucose control over the last year but my blood pressure has remained the same. I have some retinopathy issues and my ophthalmologist and optometrist want my glucose to stay at or below 6.5 % and my BP to be 120/70 mmHg. I have tried a variety of diuretics like HCTZ, Spironolactone, and Chlorthalidone, each for about 3 to 4 months but I suffer from severe dehydration whenever I take a diuretic. My eye doctors also tell me that diuretics can worsen the inflammation associated with both my dry eye and retinopathy. To add insult to injury, when I was taking the diuretics, my BP was still running at about 150/105 mmHg with no real noticeable difference.
My question then is relatively simple. I need to lower my BP to a safer rate but my doctor has run out of ideas for a third BP medicine that is not a diuretic. Can you suggest something (no-diuretic) that I could suggest to him?