High BP in the evenings: Hi! Did anyone... - British Heart Fou...

British Heart Foundation

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High BP in the evenings

WhoIsAlice profile image
14 Replies

Hi! Did anyone experienced that BP would spike in the evenings? Mine goes significantly up at 7:30-9pm with angina attacks. I’m young women recently diagnosed with hypertension - no risk factors, secondary cause not found. I suffer so much!!!

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WhoIsAlice profile image
WhoIsAlice
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14 Replies

Does the rise in your BP and Angina occur after eating? What medication are you on? What sort of device are you using to measure your BP?

WhoIsAlice profile image
WhoIsAlice in reply to

I do have a meal about 5ish pm, but it’s usually something light like salad. I eat earlier and don’t experience angina...however in the beginning when my BP was uncontrolled (up to 214/140 - end up on A&E) I was having attacks few times a day, this could happened at any time and wasn’t linked to any physical or emotional stress...My medication has been changed few times from April 2021 as BP was difficult to control. Now I take Labetalol 300mg twice a day + Amlodipine - started with 5mg and angina released for about 2 weeks but came back with this odd frequency of evening episodes, therefore Amlodipine was recently doubled.

To check BP I’ve got upper arm Boots Omron monitor. When I had 24H BP monitor fitted by hospital they also noted that my BP increased at 8pm...

Sorry for long reply, my issue has started just in April but I could write a book describing my symptoms...and I was totally fine before, well... I thought so...

in reply to WhoIsAlice

Sounds like you are having a tough time, I presume it is Vasospastic angina, there is a member on here called Milkfairy who has it I believe, she is very knowledgeable she might notice your post or if not you could send her a message.

WhoIsAlice profile image
WhoIsAlice in reply to

Thank you for your advice, hopefully I will be able to find out a little bit more...I don’t have official diagnosis (apart from hypertension) but vasospastic angina is highly possible - shortly after I started having this terrible chest pain, episodes of Raynaud’s have increased significantly, this must be connected! Raynaud’s is triggered by cold, but why angina occurs in the evenings...a mystery

Milkfairy profile image
MilkfairyHeart Star

Hello,

High blood pressure isn't usually associated with vasospastic angina.

However beta blockers can make coronary vasospasms worse.

I had a 5 day stay in hospital after being prescribed beta blockers before my diagnosis of vasospastic angina was confirmed.

Vasospastic angina tends to occur at rest in particular between midnight and 6am. Though some people experience their chest pain at other times.

The common triggers are the cold, mental and emotional stress.

I also live with Raynauds Phenomenon and experience neurological symptoms with my severe angina episodes. Basically all my blood vessels go into spasm.

Microvascular angina which is another cause of angina is associated with high blood pressure.

This type of angina is usually triggered by exercise.

Both microvascular and vasospastic angina are also called Ischaemia non obstructed coronary arteries INOCA, or Non obstructive coronary artery disease NOCAD.

Both are more common in women, they are under recognised and underdiagnosed.

Specialist testing is needed to confirm whether you have microvascular or vasospastic angina.

I suggest you keep a diary of your symptoms and ask your GP to refer you to a Cardiologist who understands women's heart disease.

The BHF has this information about the conditions.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

WhoIsAlice profile image
WhoIsAlice in reply to Milkfairy

Thank you for reply. Indeed, I need to find good specialist that would be able to diagnose me...so far my symptoms are apparently both typical and non-typical

JonathanH profile image
JonathanH

Your description rings a slight bell with me. I am very sorry that you suffer so, much more than you have described in detail. Perhaps you would like to share more of your symptoms.

I have microvascular angina, and have suffered bp spikes associated sometimes with pain. Amlodipine helped my symptoms and my bp has been better controlled since I have additionally taken diltiazem (like amlodipine, a calcium channel blocker). It may be no good for you but I mention it.

It sounds counterintuitive but gentle exercise (walking) can improve my symptoms sometimes.

Best wishes

Jonathan

WhoIsAlice profile image
WhoIsAlice in reply to JonathanH

Thank you Jonathan! First symptom that occurred was extreme burning chest pain at centre (sometimes radiates to my left arm), this was coming and going - no link with stress or exercise, lasting 2-5 min, rarely longer. Actually before that I was having headaches, but at that point I had no idea that I might have high BP. I was always fit and active, never been smoking and I was feeling healthy. Once I was put on the medication, whole series of other symptoms have started. First, I thought these are side effects of the medication, but meds have been charged and some symptoms have gone (like heart palpitations or nosebleeds), but unfortunately some remained: chest pain - very severe burning pain, but also heaviness on chest more like discomfort, fatigue, muscle aches, muscle cramps, some joint pain, lower back pain, headaches, I also get tired quickly but angina occurs when resting. In the same time I experience frequent Raynaud’s episodes.

I am confused because CT coronary angiogram showed that ‘second diagonal vessel has a critical luminal narrowing with distal reconstitution and runoff’ - according to cardiologist it’s very small vessel and although the calcification exists, it’s not life threatening or causing the pain, moreover all the rest of my arteries are completely fine. All my blood tests were ok, including cholesterol levels. Stress echo was reassuring as it was negative for prognostically significant ischemia. The cardiologist states that it is high BP causing the pain but unfortunately we have no answers why I’ve got such high BP in young age without risk factors...

Indeed, staying active and walking is good for us!

JonathanH profile image
JonathanH in reply to WhoIsAlice

Hello again,

I am sorry to be slow in replying. I am not a doctor but from my personal experience and my reading, I don't think that there is anything in your symptoms inconsistent with INOCA (ischaemia non-obstructed coronary arteries) as mentioned by HealthUnlocked's INOCA expert MilkFairy. I suffer from angina at rest, especially at night, and particularly regard that symptom as consistent with INOCA. That does not mean that you suffer from INOCA, of course.

I don't understand how your cardiologist can state that high BP causes your pain, since (1) I thought it well known that high BP tends to asymptomatic, (2) pain is a cause of elevated BP, (3) it is famously difficult to know the cause of chest pain. I have suffered from both angina and what seems to be linked gastric/oesophageal issues, indeed there is literature reporting on 2-way neurological interaction between the heart and the oesophagus.

As well as a large variety of unwelcome sensations in my chest, some of which can be described as heaviness, I suffer from musculoskeletal pain sometimes, in particular angina flare-ups are often accompanied by pain in the back of my left hip. I also suffer from head pains, but tending to experience those more as scalp sensations. I have read reports from other microvascular angina sufferers of pain, tingling and other sensations in various parts of their bodies.

Have you had an ECG? By the way, my experience of hospitals is that they are very poor at taking notice of ECG abnormalities - unless presumably they signify a heart attack or other major event. I wouldn't therefore draw any conclusions from being told that they can't find anything on your ECG. I very much recommend keeping all your ECGs in case you have an opportunity to show them to an ECG expert. I got so frustrated with medics that I became a DIY cardiologist and bought a little hand held ECG machine (Heal Force) and learned to look for indications of ischaemia (ST-depression, T-wave flattening).

Please please find somebody to be an advocate for you in your dealings with doctors. It isn't possible to be an effective advocate for yourself and you do need a friend or relative to go with you and argue your case.

I don't know if any of that helps. Mainly I want to say that you are not going mad and that you are entitled to proper medical care, which you aren't getting.

Best wishes

Jonathan

Milkfairy profile image
MilkfairyHeart Star in reply to JonathanH

Hi Jonathan,

I hope you are keeping well.

You might find this website of interest.

internationalheartspasmsall...

INOCA includes both microvascular dysfunction and coronary vasospasms.

The underlying causes of these conditions and therefore treatments are different.

ling profile image
ling

What's your diet like?Is it high in salt?

Any stomach, intestines or digestive issues?

What time is your medications?

WhoIsAlice profile image
WhoIsAlice in reply to ling

I consider my diet as balanced, trying to keep carbs low, I eat a lot of fruit and veg. I cook myself and I’ve never been using a lot of salt. I avoid take aways, ready meals and salty snacks, but to be honest I have sweet tooth...trying to cut processed sugars as much as I can. I don’t have any digestive or stomach issues. When I complained about burning pain at centre of the chest, GP offered heartburn meds, but the pain I experience is definitely NOT a heartburn, also when pain occurs my blood pressure goes high, even though I take BP medication: Labetalol - twice a day 6am& about 6pm + Amlodipine only in the morning. It happened that I took my evening medication later and pain occurred anyway.

ling profile image
ling in reply to WhoIsAlice

Pain can cause your BP to go up.

Why do you think it can't be heartburn?

Too much fruits and vegetables can destabilise the intestines as well.

If you are eating more fruits and vegetables to make up for lower carbs, that could be causing a problem.

What's do you eat for dinners?

Can I ask your age?

WhoIsAlice profile image
WhoIsAlice in reply to ling

I don’t believe that’s the heartburn because it feels differently. I’ve experienced a heartburn few times in my life...The pain I experience is much more severe, often radiates to my left arm and last short period of time, also seems to respond to calcium channel blockers. I would say it feels like inflammation and it’s nothing like acidity heartburn burning . For dinners I’m trying to keep my plate with about 40% veg/fruit, 30% protein and 30% carbs often adding some nuts /healthy fats. I’m in mine early 30s

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