Hello,
Thank you for your query at DoctorSpring.com
I have seen the case records, the cause of fluctuations of blood pressure may be due to irregular intake of medications, improper timing of the medications, high salt intake , improper measurement of blood pressure like checking the blood pressure immediately after any activity or positioning of the hand not proper.
In this case i would suggest take the drugs in this manner
Tab Nebicard 5mg at 7 am
Tab clopitab 75 mg after lunch
Tab tonact 20 mg after dinner
Tab Olmax 20 mg at 7 pm
If in spite of all the precautions taken, he still has fluctuations i would suggest to do 24 hr ambulatory blood pressure measurement.
Regards
Dr Satish
Patient replied :
Thanks for your advice. We are now taking the suggested precautions and have fixed the timing of the medicines for past one week. Listing down few observations below:
- Blood Pressure is generally highest in the morning after waking up, it lowers down after the morning walk of 30-40 mins at 7AM.
- Blood Pressure reached above 170 in last 2 days for no apparant reason.
Current medicine dosage and timings:
1/2 Olmax-40 AM at 10:00AM after breakfast.
1/2 Nebicard 2.5 at 10:00AM after breakfast.
1 Clopitorva 10 at 10:00PM after dinner.
1/2 Prazopress XL 2.5 at 10:00PM after dinner.
1 Lumia 60K (Cholecalciferol Vitamin D3 Capsule) once in a week on Friday after lunch.
Are these timings ok, or do you suggest to change the time to 7AM and 7PM (i.e. before breakfast and before dinner). Also would you suggest any change in medicine or its timing.
Also can you comment on the fluctuations in BP, it's significance and any risks involved, any other advice around the same. A General Physician suggested to use telmisartan to reduce the fluctuations, your adivce on the same?
Listing down the Blood Pressure readings at different times of the day over past 6 days.
Format : Systolic/Diastolic (Pulse)
21st June:
6:30AM 164/105 (70)
8:30AM 151/86 (70)
3:45PM 164/96 (72)
20th June:
6:45AM 143/88 (66)
8:30AM 121/76 (70)
8:00PM 176/97 (70)
10:00PM 170/97 (70)
19th June:
6:45AM 155/90 (64)
8:15AM 123/78 (70)
10:15AM 121/78 (67)
2:20PM 142/80 (60)
11:15PM 137/80 (68)
18th June:
6:45AM 151/89 (64)
8:45AM 142/83 (73)
6:15PM 145/90 (67)
10:15PM 130/87 (68)
17th June:
6:30AM 159/90 (69)
8:00AM 123/82 (76)
5:15PM 155/90 (69)
10:30PM 141/81 (67)
16th June:
8:00AM 111/66 (75)
12:00PM 139/73 (69)
5:45PM 142/87 (64)
10:15PM 135/75 (72)
15th June:
6:30AM 141/87 (67)
1:15PM 142/83 (64)
5:00PM 156/93 (75)
10:30PM 149/82 (70)
Thanks,
Piyush
Various studies have shown that blood pressure is usually high in the morning giving rise to most complications.Blood pressure fluctuation mostly commonly have been associated with Cerebro Vasucular accident( paralysis), so i would recommend the blood pressure medications to be taken in this manner . In your case you are taking majority of the anti hypertensive drugs in the morning, though they are long acting but towards the end of the day their effects come down, so it is suggested to take medicine twice a day to maintain the blood pressure.
Tab Nebicard 5mg at 7 am
Tab Olmesartan 40 mg at 7pm
Tab Clopitorva 10 mg at afternoon after food.
Monitor your blood pressure and intimate about control of blood pressure.
Reduce your salt content to 2 to 4 gms per day
Avoid eating junk food and prefer eating healthy foods
Walk4 to 5 km per day.
Regards,
Dr Satish
Patient replied :
Thanks Doctor. Just a couple of queries :
- Is it ok to take medicine before breakfast and before dinner, or does it need to be accompained with a meal, general breakfast and dinner time is 9am and 8pm.
- He is also taking 1/2 Prazopress daily at bed time now, and a full tab if BP is above 170, should it be discontinued?
- He is taking half tab of Nebicard, Olmax and Prazopress currently, as taking a full dose sometimes brings the systolic BP to below 110 (this might be due to one or more of these tabs being taken full). Your advice on this?
- Last late-night around 2am his BP shot to 180, so he took another half tab of Prazopress after the first half at 10pm, and by morning his BP went to 110. What is your advice on dealing with overshooting BP, should a variable dose of some tab can be taken on requirement basis. Or should we always stick to a fixed dose?
Thanks,
Piyush
Rather then taking three different drugs , it is better to first optimize the dosage of one medicine rather then to take three different drugs of small dosages.
Earlier the medicine is taken in the morning , its better.
There is no need to take breakfast for taking antihypertensive drugs.
Stop prazopress.
Tab OLMESARTAN 40 mg at 7pm
Tab Nebicard 5 mg at 7 am.
Monitor blood pressure periodically,
Regards
Dr Satish