Are there any medications to lower BP other than diuretics?

Question

Hi doctor,

I am a 50-year-old male with type 2 diabetes, hypertension, dry eye disease, and diabetic retinopathy. My current medications include IInsulin 100 units (slow-acting), Valsartan 320 mg, Amlodipine 10 mg, Escitalopram 10 mg, and Lifitegrast eye drops.

My HbA1c was consistently high at around 10.5% for several years. However, over the past year, I have successfully reduced it to an average of 6.5%. Despite this improvement, my blood pressure remains high, averaging 150/105 mmHg. My ophthalmologist and optometrist emphasize the importance of maintaining my glucose levels at or below 6.5% and reducing my blood pressure to 120/70 mmHg. I also experience complications from retinopathy, which further highlights the need for tighter control of these metrics.

I have tried various diuretics, including Hydrochlorothiazide (HCTZ), Spironolactone, and Chlorthalidone, each for three to four months. However, these caused severe dehydration and worsened the inflammation associated with my dry eye disease and retinopathy. Furthermore, my blood pressure remained unchanged at 150/105 mmHg despite taking the diuretics.

Given my situation, I am looking for non-diuretic options to help lower my blood pressure. Could you suggest any medications or strategies I could discuss with my doctor?

Answer 1

Hi,

Welcome to icliniq.com.

I suggest you follow a few steps to reduce your blood pressure:

Reduce salt intake and avoid alcohol, caffeine, and nicotine in any form.
Eat plenty of fruits and vegetables, and aim to maintain a healthy weight.
Exercise daily and aim for good-quality sleep, at least six hours uninterrupted at night, and one to two hours during the day if needed.
If you snore, consider treating it, as it is a common cause of resistant hypertension.

For medication adjustments, you could consider discussing the following options with your primary doctor:

Beta-blockers: Try Metoprolol succinate (50 to 100 mg per day), Atenolol (50 to 100 mg per day), or Nebivolol (2.5 to 10 mg per day).
Hydralazine: Start with 25 mg three times a day, gradually increasing to 75 mg three times a day if needed.
Alpha blockers: Options include Prazosin, Terazosin, or Doxazosin.

If your blood pressure still is not controlled after trying these options, please follow up with me.

Thank you.