Erratic hypertension

[Gillimam]

Hi. I joined to find out more about erratic blood pressure that is usually normal in the morning, but often spikes over 200 by the evening! Would like to know if others have this and how they cope with it. I also have palpitations and first degree heart block. Currently taking Candestartan 16mgs, Amlodipine 5mgs, Bispropol 2.5mgs and Apixaban 5mgs. Any advice welcome.

[devonian186]

Presumably you take BP with a cuff? What is the morning reading?

Do you take it as carefully in the evening as you do in the morning? Are there different factors present during the evening reading? For instance have you had a large meal or drunk some alcohol etc?

Best to determine if you are getting artificially high evening readings, but if they are taken under proper conditions then you need to get it checked out.

[Gillimam in reply to devonian186]

Thanks , good suggestions there. I try to keep the conditions consistent, and have been referred to a cardiologist. Just waiting now 🤞

[Tlyna]

When I first started having problems with hypertension I would often get high spikes like that at night. One time I woke about 2 am with a pounding headache and pulse in my neck and feared to move at all. I laid very still, afraid I would stroke out if I tried to sit up and reach the medication on the bedside table. I laid that way for over 2 hours terrified to move until the symptoms eased up enough that I was able to roll over, get one of the tablets and swallow it with a couple of sips of water then laid flat again. After quite some time I sat up slowly and took my BP. It was 188/130. I laid back down again and stayed still trying to slow my mind down and concentrate on relaxing. An hour or so later I took it again and it was 140/92. I have no idea how high it got at its worst and I really don't want to know but almost all of my elevated BPs have been late at night when you would think they would be lower.

I have been on several different meds for it but nearly all of them either don't work well on me or gave me some really bad side effects, three of them causing heart palpitations and one severe shortness of breath. I am now on nothing but Metoprolol Tartrate morning and bedtime now and it is keeping things steady. Since my TAVR in January the doctor has been able to lower the dose from 100 mg BID to 50 mg BID and at times my BP is low enough to skip a dose so long as I am not doing anything too strenuous. I haven't had any major spikes now in a long time.

[Gillimam in reply to Tlyna]

Sounds very scary and similar to my experience, though it tends to happen earlier in the evening and not when I'm asleep. Can I ask, what is a TVAR?

[Tlyna in reply to Gillimam]

Transcatheter Aortic Valve Replacement, I think you call it a TAVI over there. As for the timing of my spikes, I am a true night owl and am often up until between 3 and 5 am, worked midnights for decades and still can't seem to break the habit and sleep a normal schedule.

[Happyrosie]

you might get some tips and tricks from the website of the specialist charity Blood Pressure UK.

I’m sure you already know about diet and exercise, but there could be something that rings a bell for you.

[pete109]

I’ve had much the same since 2020, it’s called labile hypertension from what I’ve found online, my BP is normal for days or weeks, then for no reason at all it soars to 200+ / 100+, Just sitting, no stress, no reason, it’s a very uncomfortable feeling, almost waiting for something to go ‘bang’, apart from the intermittent high BP I had no other symptoms, been through all of the scanners in the hospital, xray, cardiac echo, MRI, CT etc. 24hr urine collection to check for excess adrenaline which ruled out “Pseudopheochromocytoma is an uncommon disorder usually manifested by severe symptomatic paroxysmal episodes of hypertension (with or without tachyarrhythmia) documented by a physician or by home blood monitoring in no particular setting or trigger”, no answer yet as to what’s causing it, test results however revealed another problem, cardiac artery disease, so had 4 stents, after which the doctors lost interest and discharged me, but I still get labile hypertension and the meds don’t stop it happening, now resorted to writing a letter to ‘the Doctor’ asking to try something else, no answer as yet, there seems to be more information on labile hypertension from US hospitals information than from NHS hospitals, look up “Labile Hypertension” or “Paroxysmal Hypertension”,strange that this started for me just when the Covid situation started, but probably a coincidence.

[Gillimam in reply to pete109]

Yes I'm very similar. It seems random and happens at rest, as you say. I have done the 24hr urine test for adrenal tumor which was normal. Awaiting referral to cardiology. If there was just something to take if and when it happens, but nothing seems to affect it. Just go to bed and hope I'm still here in the morning!😕

[pete109 in reply to Gillimam]

Something else, but related, that happens to me is that any small amount of stress causes a really inappropriate BP response, every time I go to the doctors surgery or, on the rare occasions now, to the hospital, my BP has headed off to the 200+ region, I take a BP reading before I go now and tell them otherwise they start to panic, although in those cases when I get home it rapidly goes back to normal, even holding on the phone at home to the surgery waiting in the queue causes the same BP response, fortunately apart from the cardiac artery disease, I have no other cardiac problems, never had a heart attack or any related symptoms, it’s a mystery, but very annoying now, especially as my body’s nearly out of warranty, rapidly approaching 70, 4 years trying to get a solution is a long time at this end of my life cycle.

[bluemoon572]

My wife has what is known as Labile hypertension of the elderly. It is caused by a defect in her blood pressure sensing & regulating center in the carotid artery. Like a labile diabetic instead she checks her BP at least 4 times a day. If her morning reading is 130 systolic or higher she will take her prescribed doses of lisinopril & HCTZ. At noon if her BP is trending upwards significantly, she'll take a short acting antihypertensive med called doxazosin either 2 or 4mgs depending on the level of her BP. . The same schedule and dose of it after checking her BP 6 hours later. and again at bedtime. This approach has smoothed out her labile swings both up and down.

Your GP may or may not approve it though. It certainly works safely for her.

[Gillimam in reply to bluemoon572]

Thanks for the suggestion. Worth asking doctor 🤞

[MichaelJH Heart Star]

Mine became more of a steady line when I my GP split the dose to morning and evening but subsequently needed a little tweak in the morning. This seems particularly bendficial for controlling ststolic BP. Do not try it without discussing with your GP first as it is not appropriate with all BP medications. Here is some research results on mine.

Response to twice daily Lisinopril.

[Gillimam in reply to MichaelJH]

That's really interesting. Was it similar with your systolic readings? I currently take Candestartan 16mgs in the morning, then Amlodipine 5mgs and Bispropol 2.5 in the evening as spikes to 200+ generally happen late evening.

[MichaelJH Heart Star in reply to Gillimam]

Because of long term Type I diabetes and CAD (hereditary and probably a result of raided Lp(a) as my pre-stain cholesterol was 4.2) they like to see a Systolic of 130 or below. Yet at times of stress later in the day it would hit anything from 140 - 170). I also have flashbacks and nightmares as a result of PTSD following my treatment after an amputation! This can result in similar levels. The half-life of Lisinopril is 12 hours and of Candesartan only 9 hours so theoretically to me it appears a suitable for spit doses. Bear in mind that I am nor medically qualified being a physicist.