Make no mistake about it, the dangers of high blood pressure (hypertension or HTN) have NOT been underestimated and unless you are one of those folks who “knows” when your blood pressure is too high (headache, feeling weird, etc.), most of us have no idea of what our blood pressure is. HTN increases one’s risk dramatically of cardiovascular and renal (kidney) disease. It contributes to sexual dysfunction; it adversely affects your vision; it contributes to bone loss and to insomnia (difficulty sleeping). It’s mostly silent and it is almost always deadly!

Blood Vessel Pressure

What is hypertension?

If your blood pressure is less than 120/80 you are normal (normotensive).

If your blood pressure is between 120/80 and 140/90-you are considered “prehypertensive” and are at risk for high blood pressure. Lifestyle modifications are important! Weight is a BIG factor.

If your blood pressure is 140/90 and above or 130/80 and above AND you have diabetes or chronic kidney disease then your blood pressure is high.

Often a high blood pressure reading is obtained in your doctor’s office and it is downplayed because you are anxious. However, could it also mean that whenever you are in an anxiety provoking state (like driving in city traffic or watching the end of a cliff hanger superbowl game), that you will be hypertensive as well? I see NO reason to underestimate the transcendence of a doctor’s office blood pressure reading! But perhaps of even greater significance is the routine circadian fluctuation in blood pressure and metabolism over a 24 hour period. Most people experience an increase in blood pressure during the day which peaks in the AM and then again in the evening but declines when they sleep in the evening- called dipping (typically a 10% drop in the systolic or top number blood pressure reading).If your blood pressure does not dip while asleep, your risk of cardiovascular disease (heart attacks, stokes, heart failure, etc.) is much greater.

So, what to do? First, I strongly suggest taking your blood pressure medications (except diuretics or water pills) at night. It seems fair to say that common sense as well as study data shows a decreased risk of hypertensive complications when dosing is done at night- in essence helping you “create” a dip if you do not have one normally due to metabolic issues. You might want to take a diuretic (typically just one of the antihypertensive drugs that people have been prescribed) in the day because otherwise you might spend a good part of the night awakening to urinate-creating a whole new set of problems.

Next, I would discuss with your health care provider whether it would behoove you to have a 24 hour blood pressure monitor study to assess whether you do or do not have a dip or if the night medication is addressing that issue. The monitor is not an invasive or particularly expensive procedure and your health care professional should be able to justify the procedure.  Here’s my thought – what’s the use of being diagnosed and treated for high blood pressure, if it is not treated at the right time?   

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