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Thursday, September 29, 2016
High Blood Pressure
Monthly blood pressure spikes
I have controlled hypertension. I take 100mg cozaar at 6am and 6pm daily. Also take 100mg betazok at 9am daily. This normally controls my BP daytime to below 120/70 and around 122/72 at night. However, every month I have episodes when my Bp will spike to 154/84 at night to 164/86 at night. Normally these spikes occur gradually starting at 4pm with 132/72 and increasing to a maximum around 9pm. This may go on for 3 or more days. If BP goes over 150/80 I take a nitroglycering to bring it down. This works and the BP then gets back under control for a few weeks until it spikes again. Is this a concern or do I just control the spikes with the nitroglycerin and not worry about them. My doctor gave me the nitroglycerin for the spikes. I am a 59 year old non smoking, non drinking male. Any advice is appreciated. Also the spikes only start at around 4pm never in the morning or midday unless I have had a high Bp at night and then the hig BP carries over into the morning.
It appears that your blood pressure is generally well controlled, but with episodes when the blood pressure spikes. These spikes are probably not very dangerous, but a change in your medication regimen may help to prevent them. Nitroglycerin is a short acting vasodilator. It will lower your blood pressure quickly, but is carries the risk of a rebound increase in blood pressure once its effect is gone.
You may benefit from a change in your regimen. You may want to consider adding a low dose of hydrochlorothiazide to the Cozaar, or replacing Batazok with a calcium channel blocker. It is always better to use long acting drugs that can be taken once a day. This provides smoother control and less risk of "spikes". You might want to discuss possible changes with your physician.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati