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My blood pressure value varies in the morning and afternoon. Why?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At December 8, 2020
Reviewed AtJuly 5, 2023

Patient's Query

Hello doctor,

During the day up to the afternoon, I have a blood pressure of 130/80 mmHg. In the afternoon, it is 160/90 mmHg or 160/95 mmHg. What should I do? I am a diabetic person with and heart failure. My current medications are Valsartan 80 mg in the morning, Bisoprolol 10 mg, Furosemide 25 mg, and Methyldopa 500 mg after lunch, and Lercaril 10 mg at night. I take Insulin Aspart injections three times and Levemir insulin injections once in 24 hours.

Please help.

Hello,

Welcome to icliniq.com.

It seems you have heart failure. Valsartan is recommended to be taken twice a day in heart failure. This will also lower your blood pressure. Record BP (blood pressure) by following the proper method. Moreover, you are taking Lercanidipine, which should be avoided in heart failure. And you have diabetes, so it is recommended to take cholesterol-lowering medicine Rosuvastatin 10 mg daily.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for replying.

Should I continue to take Bisoprolol, Furosemide, and Methyldopa at the same time? I do not have ischemic heart disease.

Please help.

Hello,

Welcome back to icliniq.com.

Your ejection fraction is 46 percent, which is mildly reduced. Based upon your partial echocardiography report (attachment removed to protect patient identity) and blood pressure, you should be taking the following medicines. Take Valsartan 80 mg in the morning and evening, Bisoprolol 10 mg in the morning, Furosemide 25 mg in the morning (can be skipped if there is no chest congestion, shortness of breath, and no body swelling) and Rosuvastatin 10 mg daily in the evening. Regarding Methyldopa, this is used for high blood pressure but has no beneficial effect on the heart, so if blood pressure is controlled with Valsartan, then no need for this. Regarding Lercanidipine, this medicine is used for high blood pressure but has a detrimental effect on the heart's pumping function, so this must be avoided.

1. Why are you using insulin for diabetes?

2. Do you have type 1 diabetes mellitus, or your blood sugar levels were not controllable even on multiple oral medicines?

Insulin is best for controlling blood sugar levels but has no beneficial effect on the heart, whereas some newer antidiabetic oral drugs are even beneficial for the heart and kidneys and control blood sugar levels. I prescribe those medicines unless the patient has very uncontrolled sugar levels and is given insulin as a last resort patient. Your prescription can still be refined if you tell your current symptoms, when your heart failure was diagnosed, when this echocardiography was done, etc. Send your ECG (electrocardiogram) and any other tests, such as thyroid function tests.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply.

I am using insulin for the past seven years when blood sugar went high up to 530. During the day, my blood pressure is normal, but after that, it is high. How can I control this?

Please help.

Hello,

Welcome back to icliniq.com.

I suggest you the following instructions.

1. Continue the insulin.

2. For blood pressure, take Valsartan twice a day. Additionally, adopt the following general measures to control the blood pressure.

3. Avoid smoking and other addictions.

4. Reduce salt intake in the diet. Reduce fatty foods, junk foods, and saturated fats.

5. Avoid stress and anxiety.

6. Do regular moderate-intensity exercise such as brisk walk for 30 minutes.

7. Have a proper night sleep, at least eight hours per 24 hours, including at least six hours at night (uninterrupted sleep).

8. Reduce weight even if the weight is within the normal range.

9. Drink plenty of water. Do deep breathing exercises and meditation.

10. Measure BP (blood pressure) while you are relaxed, sit for five minutes in a quiet room without talking to anyone.

11. Empty bowel and bladder before checking BP.

12. Avoid tea or coffee 30 minutes before checking BP.

13. Sit on a chair with feet on the ground, back supported, hand supported on a table, and cuff at the heart position. Check BP, and repeat after five minutes again. Then check the BP in the other arm and repeat after five minutes. During the entire period, remain relax and quiet. Arm with higher BP readings is your blood pressure. You may take at least two or more readings, and the average of readings is your actual BP.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you.

Can I use Nifedipine instead of Methyldopa because when I use this, I see that my BP gets high after one hour?

Please help.

Hi,

Welcome back to icliniq.com.

Lercanidipine, Nifedipine, Nicardipine, and Nimodipine all these drugs are called calcium channel blockers. These have adverse effects on the heart, whose ejection fraction is low. They reduce the power of pumping and lower blood pressure at the expense of raising the heart rate. High heart rate and decreased pump efficiency further deteriorate the heart's function. Amlodipine is the only calcium channel blocker used for blood pressure in heart failure if blood pressure is not adequately controlled on a maximum tolerated dose of ARBs or ABEi (drug groups). For blood pressure control, these drugs Methyldopa and Nifedipine, are given in pregnant patients only because there are many other potent antihypertensives available for nonpregnant (which are contraindicated in pregnancy).

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for replying.

During. night she has not coughed. I have seen that Methyldopa have not influenced in blood pressure? What must she do?

Please help.

Hello,

Welcome back to icliniq.com.

Thanks for the query. She was taking Valsartan 80 mg once, now she takes twice. This change in medicine may take few days to effect fully. Methyldopa also reduces blood pressure. Blood pressure keeps on changing throughout the 24 hours and that is normal. Blood Pressure will be a bit higher when one cannot sleep, or has pain in body, or stress etc. Check blood pressure multiple times per day especially when she is fully relaxed and sitting calmly. Continue taking medicines.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

I have taken Methyldopa 500 mg and my BP was high. What must I do?

Please help.

Hello,

Welcome back to icliniq.com.

Methyldopa tablet is taken 2 or 3 times per day. Are you taking Valsartan 80 mg twice a day as well? If you are taking Valsartan 80mg twice a day, Methyldopa 500mg three times a day and still your blood pressure is "persistently" high, then dose of Valsartan can even be increased to 160mg in morning 80 in evening. "Persistently high blood pressure" means that blood pressure remains high every time you check and almost everyday. If blood pressure remains within range most of times of day and 1 or 2 times its raised then this is not a problem. For example if you check blood pressure 5 times a day daily, and it is normal 4 times and high 1 time, this is not a problem. But if its high 4 times and normal 1 time almost daily, this is called uncontrolled Blood pressure. And in this case medicines are increased or changed. If you are taking only Methyldopa for blood pressure control, then it is not a good choice to control BP. It is only prescribed during high BP in pregnancy along with one or more other BP medicines.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thanks for your reply.

I take Valsartan 80mg twice a day, Bisoprolol 10 mg in the morning, and Methyldopa 500 mg one in the afternoon. Is okay?

Kindly help.

Hello,

Welcome back to icliniq.com.

Yes, it is fine. Methyldopa should be taken at least twice because it is short acting medicine. If still blood pressure remains elevated on these medicines almost Every time you check bp, then increase Valsartan to 160 mg in morning and 80 mg in evening. Another option is to continue same dosage and add tablet Amlodipine 10 mg once a day in morning. Night sleep should be adequate because if sleep is inadequate then next day bp will remain elevated. At least 6 hours uninterrupted night sleep and 2 hours sleep in day time is called adequate sleep.

Thanks and regards.

Patient's Query

Hello doctor,

What about Captopril?

Please reply.

Hello,

Welcome back to icliniq.com.

Captopril is also anti hypertensive medicine, it is short acting and needs to be taken 3 times a day. It is usually given in those patients who have newly diagnosed Hypertension or in those who have episodic Hypertension. It is also given in sudden severe Hypertension in emergency department of hospital. It should not be combined with Valsartan. Remember, ACE inhibitors (such as Captopril) and ARBs (such as Valsartan) are absolutely contraindicated in pregnancy and breastfeeding.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thanks for replying.

I use Clopidogrel and Atorvastatin are good for me? Clopidogrel has cough as side effect? I have allergies from Aspirin.

Kindly help.

Hello,

Welcome back to icliniq.com.

Thanks for the query. Clopidogrel is a blood thinner medicine. Aspirin is also blood thinner. Aspirin is given to those who have had heart attack or stroke ever in life or to those who have angina. When someone is allergic to Aspirin then Clopidogrel is given. Otherwise no need of these medicines especially in age more than 75 years. Atorvastatin is a lipid lowering medicine. It is given in those with heart attack or stroke or elevated LDL levels and high risk of heart attack and stroke. It is also given to those who have diabetes regardless the level of cholesterol. Continue Atorvastatin 20 mg daily. No need of Clopidogrel if you never had heart attack. Atorvastatin is contraindicated in pregnancy and breastfeeding. Side effects are muscular pains especially in thighs and shoulders, liver damage, generalized weakness.

I hope this helps.

Thanks and regards.

Patient's Query

Hello doctor,

Thanks for your reply.

When my BP is high, what must I do?

Please help.

Hello,

Welcome back to icliniq.com.

When you are taking regularly medicines such as Valsartan and Methyldopa, or Amlodipine, blood pressure should remain within range (it takes weeks for persistent high blood pressure to come to normal range). If still BP is high then dosage can be increased.

When blood pressure remains normal, and occasionally it rises to 180 or more, then first step is to calm down, relax, sit or lie down calmly for half an hour. Then check blood pressure, if it is still more than 180 then Captopril can be taken beneath the tongue but this is not the recommended route. It is better to swallow the tablet with water. It takes 2 to 3 hours to lower bp after taking Captopril. Try to control blood pressure on usual medicines. I hope this helps.

Thanks and regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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