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Lisa,   Thanks for your question.  As you know, you have a complicated situation that requires much thought and consideration when prescribing any medication.  Your physician, who knows your underlying medical conditions, as well as your response to different medication, is the best person to decide if a change is necessary.  If the answer is yes, then he will decide what that change should be, and discuss how they should be made.  Treating blood pressure is not a cookbook science.  It sometimes requires trials of different drugs, as well as different doses.    Please take advantage of this website to learn of other ways to help your blood pressure in addition to medication.  Also, you can search the different types of medications to gain some background for your visit with your physician.   Thanks.   Martin Cane, M.D.