I need help controlling my BP, present course is not working

[Thomas-Kutz]

  I need help on what to do. My doctor has me on Toprol XL 300mg, Accupril 40mg and HCTZ 50mg.  My BP is still high varying around 150/95. He does not seem to have any good ideas of what to pursue. All basic metabolic tests are negative.
  Heart is good, a cardiologist checked it with a Stress test. I want to bring my BP down, I eat healthy, don't smoke stopped drinking.  
  I also take lorazepam for stress. When my BP is measured after taking 0.5 tablet of lorazepam my BP is usually 135/82 about where it should be.  It seems they are doing more than all the other BP medicine.
  My BP started rather quickly about 8 months ago and they have not had much luck in getting it low.  
  What could I suggest for my him in the way of tests, medicine, etc.
  I am very frustrated I would think with all the treatments today something could be done.
  Regards,
  Tom Kutz

[CCF Cardio MD - MTR]

_
Dear Tom, thank you for your question.  Often hypertension can be difficult to control and your BP remains elevated despite treatment with 3 drugs that are usually effective in controlling hypertension.  Some patients need up to 4 or 5 medications to control hypertension adequately, but there are other causes of severe hypertension that may need to be looked into.   First, an atherosclerotic stenosis of one or both of the renal arteries could be causing your hypertension.  When the kidneys have a reduced blood supply secondary to a renal artery stenosis, the BP the kidneys actually see is much lower than the systemic BP so the regulation of BP is reset upwards which increases the systemic BP. We often screen patients with severe hypertension for renal artery stenoses. The first test that can be done for this is an ultrasound of the renal arteries (called a renal artery doppler ultrasound).  Often, an angiogram is needed if an abnormality is detected.   Renal artery stenoses can be treated with angioplasty and stents.  Second, there are numerous disorders that can cause hypertension that may need to be looked into.  Pheochromocytoma, hyperaldosteronism, and numerous disorders of the kidneys can all cause severe hypertension, but these conditions are rare.  I think your best approach would be to see your physician again and discuss the above conditions I mentioned.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.