Background: I am a male, 32, 6’ 4”, 189lbs. I have high blood pressure. I had an echo two years ago, which showed borderline global hypokinesis, an EF of 53%, and trace mitral and tricuspid regurgitation. So my cardiologist put me on bp medicine. I had issues again this past April and had a nuclear stress test, which came back normal. To help with anxiety, my cardiologist took me off an ACE inhibitor and put me on 12.5 mg of carvedilol twice a day, in addition to 12.5 mg HCTZ. I recently had palpitations after running. I went to see the cardiologist just to be on the safe side. He heard a slight murmur, which was new, so he ordered another echo. He decided to put me back on the treadmill. The stress test was normal. The echo was not perfect, but good. My EF was better, 63%. There were no signs of global hypokinesis. There is mild-moderate tricuspid regurgitation. RV systolic pressure is 17 mmHg. Tricuspid regurgitant velocity was 1.7 cm/s. Also, there is mild enlargement of my RV and LV chambers. My cardiologist did not seem alarmed and told me to go back to running and come back in three months with bp measurements.
Question: My blood pressure readings as of a month ago were usually 110-118/62-75. In the last three weeks my diastolic ranges from 77-87. I have been taking all of my meds and I started running again, but that doesn’t seem to help. What’s really weird is that in the mornings, after I wake up, my bp will read 120/82 and then ten minutes later will read 110/69, but within a couple of hours my diastolic is back up to the lower 80’s. I just has my cholesterol checked and it’s great – total: 159; LDL: 95; HDL: 46. Last checked (maybe a year ago), my protein and creatine levels were normal. What could be causing this increase in diastolic pressure? Should I be concerned with this sudden increase in my diastolic numbers?