Dionisio asked
I am 82 and have hypertension. My weight 192 and I am 5’ 10”. I also have type II diabetes with an A1C less than or equal to 6. I am taking in the morning (5-6 am): propanalol 20 mg, isosorbide 30 mg. At bedtime (10 pm): losarten 100 mg, propanalol 20 mg, amlodapine 5 mg. My BP is too low during AM but my first morning BP is high. Appreciate your suggestions.
Answer
Once diagnosed with hypertension, it is important to frequently monitor blood pressure. Even if only checked once daily, it is a good idea to vary the time of day it is checked. This is because blood pressure can vary significantly and can especially be impacted by different medications.
It is normal for blood pressure to fluctuate throughout the day and it is important to discuss this with your physician. Low blood pressure may not be a problem, however it could cause symptoms such as fatigue, dizziness, or fainting. High blood pressure in the morning could indicate a change may be needed to medications taken at night.
Some possible solutions to discuss with your physician:
- Increasing the dose of amlodipine from 5 mg to 10 mg. 10 mg is the maximum dose for amlodipine.
- Changing the dose of propranolol or switching to a long acting propranolol that can even out the blood pressure control over the course of a day.
- Adding a different medication such as hydrochlorothiazide (HCTZ). HCTZ is a diuretic that is best taken in the morning to prevent frequent urination over night.
- Checking on which type of isosorbide is prescribed. There may be a long-acting formulation that may help even out the blood pressure over the course of a day.
- Consider the impact of other medications including medications used for diabetes. These can cause hypoglycemia which may feel similar to low blood pressure symptoms.
All in all, there are many variables that go in to medication selection and medication timing. These include kidney function, age, race, past medical history, side effects, and much more. Discussing concerns with your physician is important to ensure your treatment is optimized.
