Hypertension
 

I am already on metoprolol, lisinopril and amlodipine. I cycle a lot, lost weight over the last 5 years. Yet, I recently saw my doctor and still have a hard time keeping my bottom reading under 90 and it sometimes gets above 100. I already had an aortic aneurysm I lived through likely caused by this. My new provider wrote me a script for a diuretic. I really don't want to take it so I am going to try to really limit my sodium intake to under 2000 mg a day and see if that works first. Other cyclists with hypertension; How has it gone for you managing it?

I'm taking a mix that isn't really recommended, but it works. I won't list the mix because it may not work for you. Metoprolol helped my BP, but it killed my energy level. I'm now on atenolol; better for BP and energy. I still can't get my HR very high, but I get to high RPMs; it's definitely work for me to get above , or even to, 15 mph, but I'm 80. Ah, well. I used to go for miles. Now I'll go for hours.

I've been on 2 diuretics. I felt awful on one (lasix), and didn't want to live when I was taking the other (hydrochlorthiazide). The diuretics were great for BP but horrible for quality of life.

Well, cutting your sodium down to 2000 mg a day (or less) is similar to a diuretic… less fluid volume in your circulatory system and therefore lower blood pressure.

No side effects to a low sodium diet, just adjusting your taste.

Yeah I take lisinopril and HCT. I don't care for the HCT and having to urinate as much as I do but diuretics are the front line therapy for keeping diastolic pressure down. I have been on that combo for years and it works so bot going to mess with it. I retired early in AZ last year and having to rework my hydration on a daily basis with the lack of humidity here and the HCT doing its thing LOL.

I thought hydration was good for blood pressure & conversely, de-hydration was bad for blood pressure

so dehydration IS bad for your BP. I can attest as I recently passed out during a long ride break (which I know better) because I did not hydrate before and during the ride. Still learning my new home state of AZ and while humidity is so low I was not feeling it like I did in TN LOL. When the EMTs showed up my BP was 90 over something. It was simply a dehydration event according to the ER doc.

beta blockers (metoprolol) are not really recommended as first or second line for hypertension in the absence of some other indication for them.
Historically in what order were you given your current medications?
A thiazide diuretic such as HCTZ or preferably chlorthalidone would be a logical next step. The definition of resistant hypertension is blood pressure uncontrolled on high doses of 3 medications, one of which is a diuretic. You could add one without increasing your pill count by either switching to amlodipine-benazapril (together in one capsule), stopping lisinopril and adding chlorthalidone; or switching lisinopril to lisinopril-HCTZ. You might even be able to dump the metoprolol. The diuretic should not radically increase your urination, you will just equilibrate at a lower circulating volume
I would discuss further with your new doctor.

My doc told me that amlodipine can cause fluid retention in some folks. I don't eat a lot of salt and I still need to take a diuretic. I wouldn't rule out a diuretic if your doc is recommending one. You can always stop it if you are having bad side effects.

Mine went away when I went from 360 lbs. to 170 lbs. Are you still overweight? Don't know the effect but I have been practicing IM fasting for several years. I started on a 16-8 fast which means I don't consume any calories 16 hours of every day. I mostly do an 18-20 hour fast these now with a 4-6 hour eating window.

I like MikeW's advice. HCTZ was associated with excess mortality in the MRFIT trial and ALLHAT. Maybe a different ACE inhibitor than lisinopril, or high dose? Second talking to your physician, be your own advocate.

In the pre COVID era, I never even noticed hot weather (cold weather was another matter). But now at age 83, a light 1 hour of outdoor exercising will drop my BP by 30mm. And I'm only taking half the PB med, that I take in the winter.

I went back to my PCP and my BP was good. It appears cutting down the sodium works well with exercise. No diuretic!

I am working hard to lose weight now. Back to tracking food.

I take just Losartan. I had a mild scare a few weeks ago after taking one Celebrex…made my heart rate rise and my BP went way up. It took over 48 hours to get that stuff out of my system. Caffeine made it worse. So, now I limit my caffeine intake, which by the way is a diuretic and can possibly make one’s BP go up. I do not have tea after 3:00 in the afternoon…and I’m sleeping better! Now, my BP is much better and I’m doing better things for my body so that I don’t need the Celebrex.