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High Blood Pressure

Monthly blood pressure spikes

04/04/2008

Question:

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.

Answer:

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.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati