SHOULD I REINSTATE MONO THERAPY OF 2.5 mg AMLODIPINE?

[48howardnick]

I am a 55-year old single man.  I have been primarily a vegetarian (rather "pescatarian", to be exact!).  My BMI is:  23 and has never been overweight in my lifetime.  I do treadmill jogging 5 - 6 days in a week, spending one hour on the treadmill (excluding warm up). Every time I measure my BP after 1.5 to hours following my treadmill jog (well rested), I get an optimal BP around 110/78.  I have been taking care of my diet, maintaining low sodium intake, eating mostly plant-based food with very occasional fish and eating a variety of unsalted raw nuts, legume and lentils.  I drink two home-made fresh juices every day -  beetroot first thing in the morning (before my cardio) and spinach juice usually one hour before bedtime.  I have no other health issues other than my mild to moderate OCD.  For this condition, I have been on 250 mg fluvoxamine (an SSRI) and 25 mg amitripline.   Sometimes, my sleep quality may be impaired but I keep improving.

I have been contemplating whether to continue managing my hypertension  using non-pharmacology techniques or to reinstate a recommended, first line mono therapy of 2.5 mg amlodipine  by my doctor.  I was diagnosed of hypertension about one year ago.  I took 2.5 mg amlodipine daily at 8.00 pm without fail for three months until last July, 19, 2020.  As I am still determined to treat myself without drugs,  I stopped taking the medication on July, 19, 2020 on my own (I know I have been taking risk and shouldn't have done so but I just want to give my system ONE last chance before it gets obvious that  I really need drug therapy and also, I figure the dose was very low with little or no rebound effect if terminated).  I keep tracking my day-to-day blood pressure which very rarely exceed 135/90.  With regular very low dose of 2.5 amlodipine,  my BP especially systolic had been spot on, rarely exceeding 125 even after a bad night's sleep.  My diastolic occasionally go slightly above 88.

Since my BP seems to have a marked difference in the doctor's office, I decided to be put on Ambulatory Blood Pressure Monitoring (ABPM) a month a ago.  My 24-hr average is:  137/87.  I was really anxious on the day that I was put on the device, almost consistently glancing at my BP reading every time it read.   My doc was pleased with my systolic BP but was slightly concerned of my diastolic reading.  He gave me another two months to go without drugs but optimising BP control by lifestyle.  I will have have another ABPM in a month's time - I believe to confirm or "reconfirm" that I should be medicated.

Two stress tests were administered:  Exercise - treadmill  and resting - ECHOCARDIOGRAM.  The former,  was perfectly normal.  I completed slightly longer than Stage Four on the treadmill with no problem/discomfort whatsoever.  The latter,  was also almost entirely normal except for one imperfection:  the report states that I have Stage 1 diastolic dysfunction with elevated LV filling pressure.   Additional blood test done for kidney and liver function, diabetes screening, lipid profile all shows normal functioning.

You may be wondering why I don't seem to raise all the above with my doctor but please don't ask me to do so as my doctor seems to be more inclined towards reinstating the very low dose of amlodipine.  Deep inside me, I feel that a holistic approach of  my health condition has not been well-considered.

QUESTIONS THAT I WISH TO BE ADDRESSED:

1) With the known 24-hour average of my BP:  137/87 based on the ABPM and both results of the stress, is it still a reasonably good idea for me to continue my BP management without medication?  What  is the maximum average of my BP to be more sure that I can manage without medication?   Should there be any improvement in my next AMBP, can I be more assured going drugless?  Say if my next ABPM  shows a 24-hr average of  125/85 or lower?

2) The resting stress test, EKOCARDIOGRAM states:  Stage 1 diastolic dysfunction with elevated LV filling pressure.  Is there a possible misinterpretation here as if I were not mistaken, the elevated LV filling pressure is associated to Stage 2 – 4 of diastolic hypertension.  Is Stage 1 (which is possibly usual given my age), is it a very early indication of Left Ventricular Hypertrophy (LVH)?

3) Indicatively, how many percent risk reduction of hitting CVD and kidney problems can be achieved by lowering my BP using medication along with lifestyle adjustments?  If the percentage is really low, is it worth taking medication?

I would appreciate if you could enlighten me with your professional opinion.
Thank you very much for your understanding and help.  I look forward to hearing from you!

Kind regards,

Subri Aruf