Blood Pressure Fluctuations: Causes, Medications, and Measurement Tips

Causes of Elevated Blood Pressure / Use of Antiarrhythmic Medications / Factors Affecting Systolic and Diastolic Blood Pressure / Methods for Measuring Blood Pressure

Hello, Dr.
He.
I would like to ask you some questions related to blood pressure.
I am currently 33 years old, 146 cm tall, and weigh 47.6 kg.
I am female and have systemic lupus erythematosus.
I was originally taking 5 tablets (5 mg each) of corticosteroids - Prednisolone, and I started tapering down to 4 tablets two weeks ago.
Other medications I regularly take include half a tablet of Amlodipine (50 mg), one tablet of Bisoprolol (200 mg), and one tablet of Dexamethasone (5 mg).
Additionally, I take one tablet of Omeprazole (20 mg).

Today, around July, I felt my heart racing, so I measured my heart rate with a blood pressure monitor and found my blood pressure to be quite high (lowest 124/83, highest 155/100, but mostly around 129-137/90-95).
I continued to monitor it and went for a cardiology check-up on August 24.
The doctor advised me to observe for three months and try to adjust my routine and diet, and we would see if medication would be necessary at that time.
However, starting September 21, due to migraine treatment, my doctor prescribed a rhythm control medication (10 mg) to be taken twice daily.

Here are the questions I would like to ask the doctor:
1) Starting October 3, my blood pressure frequently rose to 145-150/92-100 or higher, with diastolic pressure sometimes reaching 112.
It tends to be higher in the morning and lower in the evening.
Is this considered a sudden increase? Should I pay special attention to this or return to the cardiologist immediately? Additionally, I had an upper gastrointestinal endoscopy on October 1, and for the three days prior, I was on a liquid/low-residue diet, which, combined with several days of poor sleep quality and my menstrual period, may have affected my blood pressure in the following weeks.
Is it possible that these factors contributed to the fluctuations in my blood pressure? Furthermore, the gastrointestinal examination revealed bile reflux, and the gastroenterologist suggested it could be due to stress and autonomic nervous system issues.
Could my blood pressure also be influenced by the autonomic nervous system, causing it to rise? Lastly, since I just started taking the rhythm control medication, I sometimes forget to take it or take it at irregular times.
Could this also affect blood pressure fluctuations?
2) When I visited the neurologist, the doctor mentioned that the rhythm control medication should not be taken too late.
I would like to ask why this medication is not recommended to be taken late in the day?
3) I often see online that systolic pressure indicates the degree of vascular obstruction and diastolic pressure indicates vascular elasticity.
I would like to confirm with the doctor if this is accurate, as well as the factors that affect systolic and diastolic pressures.
Does fluid intake and exercise influence diastolic pressure? Additionally, I have a habit of staying up late; does this affect the levels of diastolic pressure (vascular stiffness/vessel elasticity)?
4) Finally, I would like to ask if blood pressure measurements taken around noon tend to be higher.
I see online recommendations to measure blood pressure upon waking and before sleeping.
I am uncertain if this recommendation refers to measuring before any activity after waking or shortly after getting up, or if it specifically refers to the morning.
I usually wake up close to noon, wash up, drink a cup of warm water, rest for about ten minutes, and then measure my blood pressure.
Is this an appropriate method for measuring blood pressure? Thank you! Ann

Ann, 30~39 year old female. Ask Date: 2022/10/13

Dr. He Dongjin reply Cardiology

Hello, both your attending physician and I do not believe that you have hypertension; it sounds more like autonomic nervous system dysregulation or fluctuations in blood pressure caused by changes in both external and internal environments.
External factors include weather and seasonal changes, while internal factors include sleep quality, emotions, menstrual cycle, and variations in pre-existing conditions such as lupus and gastrointestinal issues, all of which can affect blood pressure.
Therefore, your attending physician has only prescribed a medication for heart rhythm, which is a drug that helps to stabilize the autonomic nervous system.
1.
There is no need for an immediate follow-up appointment.
2.
I am not sure why it is not recommended to eat too late; you can ask her about this during your next visit.
3.
Systolic blood pressure indicates the degree of vascular obstruction, while diastolic blood pressure reflects vascular elasticity.
I would like to confirm with the doctor if this is accurate; it is not necessarily so.
4.
After getting up, washing up, and drinking a cup of warm water, resting for about ten minutes before measuring blood pressure—I'm not sure if this method of measuring blood pressure is correct, as everyone's daily routine and wake-up times can vary.
Monitoring at your own schedule is acceptable.
Changhua Hospital cares about you.

Reply Date: 2022/10/13

More Info

Hello Ann,
Thank you for your detailed inquiry regarding your blood pressure fluctuations and related health concerns. Given your medical history, including lupus and the medications you are taking, it’s essential to approach your situation with a comprehensive understanding of how various factors can influence blood pressure.

1. Blood Pressure Fluctuations
Your recent blood pressure readings, particularly the systolic values reaching 145-150 mmHg and diastolic values around 92-100 mmHg, indicate a significant increase compared to your previous measurements. This could be considered a sudden change, especially if you have been consistently within a lower range prior to this. Factors such as stress, changes in medication, sleep quality, and hormonal fluctuations during your menstrual cycle can all contribute to these variations.
The fact that you noted higher readings upon waking and lower readings in the evening is not uncommon. Blood pressure can naturally fluctuate throughout the day due to various physiological factors, including activity levels, stress, and even dietary intake. However, if your readings consistently exceed 140/90 mmHg, it would be advisable to consult your cardiologist sooner rather than later, especially given your history of lupus and current medications.

2. Medication Adherence
You mentioned occasionally forgetting to take your heart rhythm medication (心律錠). Inconsistent medication adherence can lead to fluctuations in blood pressure and heart rate, as these medications are designed to stabilize your cardiovascular system. It’s crucial to take medications as prescribed and at the same time each day to maintain steady levels in your bloodstream. If you find it challenging to remember, consider using a pill organizer or setting reminders on your phone.

3. Timing of Medication
Regarding the timing of your heart rhythm medication, it’s generally advised not to take it too late in the evening because it can affect your heart rate and blood pressure during the night. Some medications can cause increased heart rate or blood pressure, which might disrupt your sleep or lead to nocturnal symptoms. Discuss with your doctor the best time for you to take this medication based on your daily routine.

4. Understanding Blood Pressure Readings
The distinction between systolic (the top number) and diastolic (the bottom number) pressures is indeed significant. Systolic pressure reflects the force of blood against the artery walls when the heart beats, while diastolic pressure indicates the pressure when the heart is at rest between beats. High systolic pressure can suggest increased vascular resistance or stiffness, while high diastolic pressure may indicate issues with vascular elasticity.

Factors such as hydration, physical activity, and even sleep patterns can influence these readings. For instance, dehydration can lead to higher systolic pressure, while adequate hydration and regular exercise can help improve diastolic pressure by enhancing vascular health.

5. Measuring Blood Pressure
As for the best times to measure your blood pressure, it is generally recommended to take readings in the morning before any activity and in the evening. This helps to establish a baseline and track any significant changes. If you wake up close to noon, it’s still beneficial to measure your blood pressure after a brief period of rest and hydration. However, ensure that you are not engaging in any strenuous activity or consuming caffeine immediately before taking your measurement, as these can artificially elevate your readings.

Conclusion
In summary, your blood pressure fluctuations could be influenced by a combination of medication adherence, lifestyle factors, and physiological changes. It’s essential to monitor your blood pressure regularly and maintain open communication with your healthcare providers. If your readings remain elevated or you experience any concerning symptoms, please seek medical advice promptly.
Take care, and I hope this information helps you manage your health effectively.

Best regards.

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