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. HBP runs around 150/105.
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. 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 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?
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Reduce salt intake. Avoid alcohol and caffeine and nicotine in any form. Take plenty of fruits and vegetables. Reduce weight, do daily exercise. Take sleep of good quantity and quality, at least six hours uninterrupted sleep at night and 1 to 2 hours at day time. If you snore, treat it. It is one of the main cause of resistant hypertension.
Then, you may take beta blocker as next addition such as Metoprolol succinate 50 to 100 mg per day, Atenolol 50 to 100 mg per day or Nebivolol 2.5 to 10 mg per day. Then you may add Hydralazine 25 mg thrice a day to 75 mg thrice a day. Also, the option is for alpha blockers such as Prazosin, Terazosin, and Doxazocin. Also other options. Consult your primary doctor with these ideas. If still BP is not controlled, follow-up with me.
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