Daily Blood Pressure Pattern
Blood pressure follows a daily pattern. It is normally lower at night while you are sleeping and starts to rise a few hours before you wake up. This rise in BP continues during the day, usually peaking in the middle of the afternoon. By late afternoon or evening, your BP would begin to drop again.
Some people experience abnormality in their BP pattern. One of it is a morning surge in BP , which results in increased risk of damage to the brain, heart and kidneys. Morning hypertension could also happen in those with well-controlled BP.
Why Your Blood Pressure Can Remain High On Medication
While blood pressure medication can drastically reduce your blood pressure over time, it can still remain above normal levels. Learn more about high blood pressure, medications commonly used to treat it, and why your blood pressure can stay high on medication.
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High blood pressure is a common condition in the US, affecting around 47% of the population.
Blood pressure is the amount of strain or force your blood puts on your blood vessels as it circulates throughout your body. Your heart beats continuously, and it takes large amounts of force to move blood from one area of your body to another.
When your blood pressure is higher than normal, it can put a lot of wear and tear on your blood vessels. This puts you at risk of other health conditions.
How blood pressure is measured
Blood pressure measurements give two different numbers, systolic and diastolic blood pressure, both of which are measured in mm Hg .
Systolic blood pressure, the top number, shows the amount of pressure placed on your blood vessels when your heart beats. Diastolic blood pressure, the bottom number, indicates the amount of pressure your blood puts on your blood vessels between beats.
Blood pressure readings higher than 120/80mm Hg have the following categories:
How Do I Know If I Have Morning Hypertension
Having a home blood pressure monitor at hand can be useful in determining whether you have morning hypertension. These devices are easily available at your neighbourhood pharmacy, and are reasonably priced. There are several types of monitors available, so talk to your pharmacist about the type of model that would suit you best.
It is best to check your BP, using the same arm each time, at the following times:
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You Shouldnt Ignore White Coat Hypertension
Some people experience white coat hypertension, when blood pressure is elevated in the doctors office but not in other settings. These patients need to monitor their blood pressure at home or wear an ambulatory blood pressure monitor that takes your blood pressure every 30 minutes for 24 hours.
While white coat hypertension was formerly considered simple nervousness, recent research suggests otherwise.
A study published in the journal Hypertension found that people with white coat hypertension are at a significantly greater risk for developing sustained high blood pressure than people who have normal blood pressure. One possible explanation is that people with white coat hypertension have a harder time managing stress and anxiety.
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Does Your Blood Pressure Change While You Sleep
When youre asleep your blood pressure is generally lower than while youre awake. This is totally normal and is known as nocturnal dipping. The drop in both your blood pressure can be up to 20% lower than your readings in the day time.
People who dont have lower blood pressure while they sleep have been shown to be at higher risk of heart disease and stroke.
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Ask The Doctor: Should I Worry About Low Nighttime Blood Pressure
Q. My systolic blood pressure is high in the morning , but in the evening it drops to below 100. I am taking two blood pressure medications daily and still experiencing seriously low blood pressure at night. What would you suggest?
A. Everyone’s blood pressure changes throughout the day, and it’s often highest in the morning and lowest at night. You seem worried about the low pressure at night, but that would concern me only if it’s accompanied by symptoms such as dizziness or fainting. A systolic pressure below the normal of 120 is usually not worrisome. In fact, studies show that low blood pressure while you are sleeping predicts low cardiovascular risk.
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What Causes High Blood Pressure In The Morning
Every person has a circadian rhythm, which is a 24-hour cycle that regulates the sleep-wake cycle. Morning hours are usually when a person wakes. Upon waking, the body releases different chemicals, like adrenaline and cortisol, to give you energy and jumpstart your day. Though beneficial, these chemicals can cause a natural increase in blood pressure, which puts people that live with high blood pressure at an increased risk for complications.
There are two types of high blood pressure in the morning. The first one is nocturnal hypertension. Nocturnal hypertension is high blood pressure that extends from nighttime to morning time. The second is morning surge hypertension. Morning surge hypertension is blood pressure that increases in the morning.
High blood pressure in the morning has been linked to organ damage to the brain, heart, and kidneys. It has also been linked to causing silent strokes, heart attacks, and other cardiovascular complications.
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Common Causes Of High Blood Pressure Spikes
Some people with high blood pressure will experience sharp rises in their blood pressure. These spikes, which typically last only a short period of time, are also known as sudden high blood pressure. These are some possible causes:
- Certain medications or combinations of medications
- Chronic kidney disease
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Understanding Your Blood Pressure Reading
Blood pressure is measured in millimetres of mercury and is given as 2 figures:
- systolic pressure the pressure when your heart pushes blood out
- diastolic pressure the pressure when your heart rests between beats
For example, if your blood pressure is 140 over 90, or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.
As a general guide:
- high blood pressure is considered to be 140/90mmHg or higher or 150/90mmHg or higher if youre over the age of 80
- ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg, while the target for over-80s is below 150/90mmHg
Blood pressure readings between 120/80mmHg and 140/90mmHg could mean youre at risk of developing high blood pressure if you do not take steps to keep your blood pressure under control.
Page last reviewed: 23 October 2019 Next review due: 23 October 2022
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How Hypertension Is Affected By Sleep
There is a clear link between the amount of sleep someone gets and their risk of high blood pressure. In a recentstudyVerified SourceAmerican Academy of Sleep MedicineSociety focused on sleep medicine and disorders, and the AASM is who authorizes U.S. sleep medicine facilities.View sourceon the relationship between sleep duration and the risk of hypertension, researchers found those who slept less than 4 hours a night were at a much higher risk than those who slept 7 hours each night.
However, this study also found that sleeping too long can also increase your risk of high blood pressurethis issue can be avoided by getting the recommended amount of sleep each and every night, which varies from person to person.
In another study, researchers found that people who only slept six hours the previous night are shown to have higher blood pressure the next day as compared to those who had a great nights sleep. Continued lack of sleep can only compound this effect. Without proper sleep to revitalize your body, you could be stressing yourself without even realizing it until it is too late.
Dr. Michael Grandner, a clinical psychologist and Director of the Sleep and Health Research Program, says, Hypertension is a key cardiovascular risk factor. There are now many studies that have been able to show that insufficient sleep and poor sleep quality are related to the development of high blood pressure and other aspects of heart disease.
Poor Sleep And Hypertension
Sleep is closely linked to hypertension. Even one night of poor sleep can raise your blood pressure. Sleeping less than 7 hours for a number of nights in a row can increase your blood pressure and your risk of developing hypertension. Poor sleep quality affects your blood pressure and your heart more than you realize.
If you have sleep apnea, you have an even higher risk of developing hypertension. This is because you consistently sleep poorly, and this leads to a rise in blood pressure. Sleep apnea can further increase blood pressure by restricting the flow of oxygen during sleep.
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Possible Risk Factors Resulting In Non
There are several risk factors that may result in your blood pressure rising at night. Night shift work is one of them as already shown by the study we alluded to above. Stress and anxiety are also other factors that may result in non-dipping blood pressure at night. Some individuals have found relief through meditation. Life style related issues such as the use of tobacco also increases the risk of elevated blood pressure at nighttime. Lastly, for individuals on high blood pressure medications, taking medication that does not cover the entire 24-hrs is also a possible cause of nighttime high blood pressure. While many people conclude they have blood pressure which rises at night based on personal home measurement of blood pressure, to get a professional diagnosis it is important to go under a 24-hour blood pressure monitoring test.
How Is Morning Hypertension Treated
Morning hypertension generally happens because the effects of the antihypertensive medications a person is on do not last for 24 hours. Hence, your doctor may recommend antihypertensive medications that target morning hypertension to be combined with your existing hypertension treatment.
Before this additional medication is prescribed, the first step of treatment is self-monitoring of early morning blood pressure at home. Once you have been diagnosed with morning hypertension, your doctor will adjust your medications to reduce the surge in morning BP.
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Sleep Apnea Forces The Heart To Work Harder
The airway blockages created by obstructive sleep apnea cause your blood pressure to increase, because your heart is working harder to get oxygenated blood flowing through your body.
While youre asleep, sleep apnea triggers the brain to pump more blood to key areas like the brain and heart. This puts added pressure on your artery walls and spikes your blood pressure higher than if you were breathing normally while asleep.
Should I Take My Blood Pressure Medication At Night
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Doctors often suggest taking daily medication in the morning, as part of your start-the-day routine. A recent study, however, suggests that taking your blood pressure medicines at night may offer important cardiovascular protective benefits. Dr. Allen J. Taylor, chairman of cardiology at MedStar Heart and Vascular Institute, gives us his thoughts on the study and what patients should know.
This large study, recently published in the European Heart Journal, certainly caught my attention. The eye-opener: study patients who took their prescribed blood pressure medicines at bedtime had a dramatically lower risk for serious cardiovascular conditions and death than people taking their medicines in the morning. Besides better controlling their blood pressure overall, patients who dosed at night experienced:
- 56% lower risk of death due to heart or blood vessel conditions
- 49% lower risk of stroke
- 34% lower risk of heart attack
- 40% lower risk of needing surgery to open or widen a vessel supplying blood to the heart
These impressive results seem almost too good to be true and, like all studies, the benefits should be validated and confirmed with more studies. Still, its large size and long duration give this current study considerable credibility.
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Secondary High Blood Pressure
Some cases of high blood pressure are the result of underlying factors or cause and this is known as secondary high blood pressure.
Underlying factors include:
- kidney conditions, such as a kidney infection, or kidney disease
- narrowing of the arteries
- hormonal conditions, such as Cushing’s syndrome
- conditions that affect the bodys tissue, such as lupus
- medication, such as the oral contraceptive pill, or the type of painkillers that are known as nonsteroidal anti-inflammatory drugs , such as ibuprofen
- recreational drugs, such as cocaine, amphetamines and crystal meth
Occasionally, a rise in blood pressure can result from taking herbal remedies, such as herbal supplements.
Is It Possible To Stabilize Blood Pressure And Reduce Fluctuations
Blood pressure fluctuations can make it challenging to take an accurate, meaningful reading, and severe fluctuations can increase your risk of health problems. You might be wondering if there’s anything you can do to reduce this variability and stabilize your blood pressure.
Your first priority should be to continue taking your medication as directed. Your blood pressure should stabilize with effective treatment, so talk to your doctor if youre concerned about your readings.
If medication is ineffective, you might have resistant hypertension or an underlying health condition.
Your doctor can make specific suggestions depending on your individual symptoms and how your blood pressure fluctuates. This might include taking your blood pressure medication at bedtime to reduce nighttime blood pressure, taking them in the morning if your blood pressure is dropping too low, or exercising at a different time of day.
If you have resistant hypertension, there are surgical treatments available as a last-resort option.
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What We Knowand Dont Knowabout High Blood Pressure And Sleep Deficiency
Researchers estimate that people who frequently get fewer than 6 hours of sleep per night are up to 32% more likely to develop hypertension than those sleeping 7 to 8 hours. The consequences of too little sleep could be even bleaker for people who already have hypertension. In a recent study in the Journal of the American Heart Association, people with hypertension who slept fewer than 6 hours per night were twice as likely to die from a heart attack or stroke than those getting 7 to 8 hours.
Its still unclear exactly how sleep protects the heart, or how too little sleep can cause trouble.
One problem may be that shortened sleep seems to disrupt the bodys ability to regulate or rebalance stress hormones, which can raise your blood pressure. Lack of sleep is also linked to increased inflammation, which can strain the heart. And it can interrupt the natural nighttime blood pressure dip that correlates with better blood pressure during the day. In addition, insufficient sleep appears to throw off the bodys appetite-control hormones, which can lead to overeating, obesity, and poor blood sugar control and, in turn, hypertension and other heart health risks.
Learning more about what happens in the body during sleep is an active area of research these days. But clearly, sleep has important health-protective benefits.
Why Does My Blood Pressure Vary Throughout The Day
You may have heard the term circadian rhythm. If so, you know this is not a beat to keep on the dance floor. It is a biological cycle your body follows. As defined by the National Institute of General Medical Sciences, âCircadian rhythms are physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organisms environment.â As your body cycles through this rhythm each day, responding to both internal and external stimuli, your blood pressure is affected.
The study of these important rhythms, known as chronobiology, was founded by Franz Halberg. His work in this field has helped identify abnormal rhythms in day-night blood pressure readings.Keeping the Beat of Blood PressureFollowing this chronobiological rhythm, your blood pressure is normally higher during the daytime and lower at night, during sleeping hours. Hereâs the problem. People with high blood pressure often donât experience this night time dip. This lack of a lowering of blood pressure at night is referred to as non-dipping.Whatâs the big deal? Heart attack and stroke have been found to be associated with non-dipping. Your blood pressure stays elevated, and your body is not in the relaxed state it should be during rest.
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Slightly Higher Blood Pressure In The Morning Is Normal Because Your Blood Pressure Falls At Night And Needs To Work A Little Harder When You Wake Up A Very Large Increase Should Be Reported To Your Doctor
Let your doctor know if you have a morning blood pressure that is 10 points above your daytime blood pressure.
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If you monitor your blood pressure at home, you may notice that your pressure is usually higher in the early morning. This is normal because your blood pressure has a normal variation that follows your bodys biological clock, also called your circadian rhythm. Blood pressure is higher a few hours before and after waking up. It peaks at about midday, drops in the evening, and is lowest during deep sleep, called your nocturnal blood pressure.
Some people have a higher increase in morning blood pressure, called a morning blood pressure surge . It is known that most strokes, heart attacks, and sudden deaths occur in the early morning, so for several years researchers have been trying to find out if MBPS is a risk factor for cardiovascular disease . The research has not been conclusive, but it seems to suggest that there is a slightly higher risk, especially for stroke, that increases as MBPS increases.