Blood Pressure Spikes: Causes, Timing, and Medication Effects

Q: Blood Pressure Spikes: Causes, Timing, and Medication Effects

Hello, Q1 and Q2： Any discomfort may lead to a spike in blood pressure. <br>If there is gastrointestinal discomfort, consider whether it might be gastroesophageal reflux disease (GERD). <br>Q3： Labetalol has autonomic nervous system relaxing properties, and it is very likely that

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Dear Dr.
He,
Thank you very much for your professional responses and suggestions in the inquiries regarding medication #194653 and #194617.
My mother expresses her heartfelt gratitude to you.
However, we still have some questions and would like to trouble you further:
Q1.
You mentioned, "In my opinion, my mother may not necessarily have hypertension or may only have mild hypertension." This made my mother think that before her blood pressure spikes to over 200/100, she often experiences gastrointestinal discomfort, specifically symptoms such as bloating, abdominal pain, and a feeling of pressure in her chest with difficulty in expelling gas.
Could you please advise, based on the above, whether my mother's blood pressure spikes are caused by gastrointestinal issues (bloating, abdominal pain) rather than pure hypertension?
Q2.
Following up on the previous question, my mother's blood pressure has spiked to over 200/100 approximately 5 to 6 times since last April, mostly occurring at night, in the early morning, and during the morning hours, specifically between 9 PM and 7 AM.
There have been almost no occurrences during the daytime.
Could you please explain why my mother's blood pressure spikes predominantly happen at night, in the early morning, and during the morning, but not during the day?
Q3.
When my mother's blood pressure spikes to over 200/100, she immediately takes "Diovan (160 mg)," but it has never successfully lowered her blood pressure.
However, taking "Labetalol (200 mg)" has successfully reduced her blood pressure each time.
Could you please explain the reason for this difference in efficacy between these two medications?
Q4.
You mentioned that "Diovan (160 mg)" is less effective compared to "Sevikar (5/20)" and seems to be weaker than "Labetalol (200 mg)." However, my mother experiences dizziness and fatigue as side effects even with the least effective medication, "Diovan (160 mg)." Since her primary physician has advised her to take "Diovan" regularly, she is hesitant to reduce or stop the medication on her own.
If we want to alleviate the dizziness and fatigue side effects caused by "Diovan," aside from reducing or stopping the medication, are there other methods to help mitigate these side effects? Or will the side effects naturally subside after my mother has been on "Diovan" for a while as her body adjusts?
Thank you, Dr.
He.

Axiang, 40~49 year old female. Ask Date: 2023/03/25

Dr. He Dongjin reply Cardiology

Hello, Q1 and Q2: Any discomfort may lead to a spike in blood pressure.
If there is gastrointestinal discomfort, consider whether it might be gastroesophageal reflux disease (GERD).
Q3: Labetalol has autonomic nervous system relaxing properties, and it is very likely that your anxiety is causing your blood pressure to rise continuously.
Q4: In my opinion, you should either reduce the dosage by half or not take it at all, but you still need to eat.
I'm not sure how to reduce side effects; perhaps they will naturally diminish with time.
Each person's constitution is different, so it's hard to say.
You will have to try it to find out.
Changhua Hospital cares about you.

Reply Date: 2023/03/25

More Info

Understanding blood pressure spikes is crucial for managing hypertension and ensuring overall cardiovascular health. Based on the information provided, it appears that your mother experiences significant fluctuations in blood pressure, particularly spikes to 200/100 mmHg, often accompanied by gastrointestinal discomfort. Let's address your questions systematically.

Q1: Could gastrointestinal issues cause blood pressure spikes?
Yes, gastrointestinal discomfort, such as bloating and pain, can indeed contribute to temporary increases in blood pressure. The body's response to pain or discomfort often involves the release of stress hormones like adrenaline, which can lead to vasoconstriction (narrowing of blood vessels) and increased heart rate, both of which elevate blood pressure. Additionally, discomfort can lead to anxiety, further exacerbating the situation. It's important to consider that while these spikes may be related to gastrointestinal issues, they could also indicate an underlying problem with blood pressure regulation.

Q2: Why do blood pressure spikes occur more frequently at night or early morning?
Blood pressure naturally fluctuates throughout the day, typically peaking in the late afternoon and dipping at night. However, certain factors can disrupt this pattern. For your mother, the spikes occurring at night or early morning could be influenced by several factors:
1. Circadian Rhythms: The body’s biological clock can affect blood pressure regulation. Some individuals experience higher blood pressure during the night due to hormonal changes.

2. Medication Timing: If her medications are not timed correctly, they may wear off during the night, leading to elevated blood pressure upon waking.

3. Sleep Apnea: If your mother has sleep apnea, it can cause significant fluctuations in blood pressure during sleep, often leading to spikes upon waking.

4. Dietary Factors: Eating heavy meals or consuming high-sodium foods in the evening can also contribute to nighttime hypertension.

Q3: Why does "Labtal" effectively lower blood pressure while "Diovan" does not?
The difference in efficacy between "Labtal" (Labetalol) and "Diovan" (Valsartan) can be attributed to their mechanisms of action. Labetalol is a combined alpha and beta-blocker, which means it reduces heart rate and dilates blood vessels, leading to a more significant drop in blood pressure. In contrast, Valsartan is an angiotensin II receptor blocker (ARB) that primarily works by relaxing blood vessels. If your mother’s blood pressure spikes are severe, Labetalol may provide a more immediate and effective response.

Q4: How to manage side effects from "Diovan"?
Experiencing dizziness and fatigue while on "Diovan" is not uncommon, especially when starting the medication or adjusting the dosage. Here are some strategies to manage these side effects:
1. Hydration: Ensure your mother stays well-hydrated, as dehydration can exacerbate dizziness.

2. Gradual Position Changes: Encourage her to rise slowly from sitting or lying positions to minimize dizziness.

3. Dietary Adjustments: A diet rich in potassium (found in bananas, oranges, and spinach) can help counteract some side effects of blood pressure medications.

4. Regular Monitoring: Keep track of her blood pressure regularly to ensure it remains within a safe range, and report any significant changes to her healthcare provider.

5. Consultation with Healthcare Provider: If side effects persist, it’s essential to discuss them with her doctor. They may adjust the dosage or consider alternative medications that might be better tolerated.

6. Time for Adaptation: Sometimes, the body may adapt to the medication over time, leading to a reduction in side effects. However, this varies from person to person.

In conclusion, managing blood pressure spikes involves a comprehensive approach that includes monitoring, medication management, and lifestyle adjustments. It’s essential to maintain open communication with healthcare providers to tailor the treatment plan to your mother’s specific needs. Regular follow-ups and adjustments based on her response to treatment will be key in managing her hypertension effectively.

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