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High Blood Pressure

Re: Daily 3pm afternoon BP rise

09/04/2007

Question:

I take 100 mg of cozaar at 7pm daily and 100 mg of Betazok(Toprol XL) at 8am daily. My blood pressure seems to be controlled in the day at 115/60 until about 3pm everyday. Then it will rise to 124/60 to a maximum of 130/80 at around 9pm. The cozaar is taken at 7pm. Then later at night and in the morning my BP is back in the 120/80 range or lower until again at 3pm it will increase. I think the half life of the blood pressure medicine may be the cause of this daily occurrance. Is it possible I need a larger dose of the Betazok in the morning or maybe a small dose of cozaar at midday. I have problems with diuritics, and calcium channel blocker as well as the Ace meds. Or do I need a longer acting medicine like cozaar. I am not sure how to approach my doctor here. Any infor is helpful.

Answer:

The blood pressure varies during the day in everybody.  This is true of normotensive and hypertensive people, treated or not.  In your case, the blood pressure does not rise above 130/80, which indicates good control.

The easiest way to improve blood pressure control further would probably be to increase Toprol XL to 150 mg daily.  An increase in the dose of Cozaar is less likely to lower your blood pressure more.  If you find it easy to take Toprol XL in the morning and Cozaar in the evening, I would continue this timing.  Once your blood pressure is well controlled, you don't have to take it every day.  Checking it twice a week should be more than adequate.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati