BP Varies - Do I even have hypertension?

HISTORY

46 year-old white male, 6', 155 lbs. Active, I raced bicycles for many years, still ride recreationally, about 100 mi/wk in the summer, fast pace. Low fat diet, moderate alcohol use (1 gl red wine per day), no caffiene (quit recently). Normal blood test and thyroid results, cholesterol in mid-150 range.

I was diagnosed with an aneurysm of the ascending aorta early this year, caught it on an echocardiogram (I was there for a minor arrhythmia problem that turned out to be nothing). I underwent surgery on 2/2 of this year to replace the aneurysm with a Dacron graft. The operation went very well, no damage to my aortic valve, no need for reimplantation of my coronary arteries. I recovered quickly and was back to riding my bike in about 5 weeks. Likely cause was determined to have been a congenital defect, not systemic collegen disease (e.g. Marfan's).

Prior to my diagnosis, my bp was 120/80 as measured at my PCP and at my first cardiologist visit. My PCP shows a history of normal bp extending back at least 5 years. I had one incident of higher bp about 10+ years ago as measured by a former PCP. I bought a monitor, watched my bp for several months, saw no sustained high bp. No changes made in diet or any drug therapy used.

PROBLEMS

After my diagnosis, my bp was elevated (as you might expect, due to stress) to about 130/90. My cardiologist and cardiac surgeon both said that I now had high bp and it needed to be treated. I was put on 50 mg of metoprolol (B-blocker), taken in 25 mg doses twice daily. My bp after discharge was in the 110/70 range.

About 3 weeks after my surgery, I noted my bp was increased to about 130/90 in the mornings and evenings, dropping somewhat during the day. It continued to increase to as much as 150/100 in the mornings/evenings as time passed, and I had so much pounding of my heart at night I had difficulty sleeping. My cardiologist's first recommendation was to double my metoprolol - that made things worse, IMO. I had zero exercise capacity at 100 mg daily, and my bp was still high. I begged them to put me on something different or in addition, they relented and perscribed irbesartan (Avapro, an ARB) at 150 mg daily in a single dose. After a week (takes time for ARB's to work), my pressure dropped to about 115/80, then kept dropping, to as low as 90/60. I could exercise fine, but would get dizzy on standing.

About 4 days ago, my morning/evening pressure started to increase again. I have made no changes in my med levels, diet, or exercise during this period. My pressure is now up to 150/100 in the mornings, dropping to about 115/80 after I take my meds. A visit to my cardiologist yesterday, where I related all the info above, resulted in nothing useful ("take more metoprolol").

QUESTIONS

1. Do I even have hypertension? My previous medical history didn't indicate it, and the drugs seem to often make it worse, not better.

2. Why would my pressure go UP at night? Shouldn't it go down? What would make it behave that way?

3. I have eliminated caffiene from my diet, cut my alcohol intake down to 1 gl of wine daily, and have tried to eliminate as much sodium from my diet as possible. I eat two bananas a day for increased potassium. I'm already as skinny as a rail. What else can I do?

4. Where can I get a clinician who will actually WORK with me on my bp management? My PCP and cardiologist have been of little assistance in this area. I live in Phoenix.

thanks for any help,

PB Anders