Thanks for your question. Before going into the choices of other medication, has your doctor looked for a cause for your hypertension? You mentioned that your creatinine is elevated, but you've not stated how long you have been hypertensive and how old you are. Long standing hypertension can affect your kidneys, and if you have not had high blood pressure for more than 5 years, I would consider the possibility that the elevated creatinine may be an indicator of another problem. Your pressure may be the result of a problem and not the cause. You should have a chest X-ray, urinalysis, 24 hour urine collection for creatinine and protein. If you pressure is very high, there are other 24 hour urine studies that your doctor should also consider (VMA levels), but this should be done on a special diet. He should also consider a nuclear scan of your kidneys using captopril (an ACE inhibitor) to see if there is any delay in function in one kidney when compared to the other, as well as checking for any narrowing of one of the renal arteries that supply your kidneys with blood. When an artery is narrowed, the kidney interprets this as low pressure, and therefore produces a hormone, rennin, that helps to raise the pressure. In addition routine Blood count (CBC), chemistry screen, thyroid function studies, and lipid panel should also be performed.
If all of the above is normal, then you most likely have Essential Hypertension, which means that there is no cause for your elevation, it just occurs on its own. Your doctor, hopefully has tried several dosage changes of your medication. He could also combine your medication, giving you both the beta blocker and the ACE inhibitor. Other categories of medication to consider are calcium channel blockers, Angiotensin receptor blockers (ARBs), alpha blockers, diuretics, and some lesser used drugs reserved for difficult to control situations such as minoxidil. Many of these drugs can be used in combination to achieve control. In many patients, finding the right medication, combination of medications, and dosage can be trial and error. Patience and perseverance is required by both the patient and the doctor.
I hope this has been helpful. Best wishes.
Martin Cane, M.D.