Managing Morning Blood Pressure and Heart Rate: Expert Insights on Medication Use

Q: Managing Morning Blood Pressure and Heart Rate: Expert Insights on Medication Use

Hello, <br>Q1： There are many causes of autonomic nervous system disorders, and it is difficult to pinpoint the exact reason. <br><br>Q2： Taking medication when necessary does not mean it is stronger or harmful to the body. <br>Generally, the strengths of Amlodipine (referred to

Follow-up Inquiry #196108 Consultation

Dear Dr.
He,
Thank you very much for your response and suggestions in the inquiry consultation "#196108." I would like to express my gratitude on behalf of my mother.
I have some additional questions for you as follows:
Q1.
Recently, my mother experiences increased heart rate and elevated blood pressure (systolic pressure around 160-180 mmHg) upon waking up in the morning (around 6-7 AM).
Taking "Labtal (Labetalol) 200 mg" at that time provides immediate relief (heart rate decreases, and systolic pressure drops to around 110-120 mmHg).
It seems that your assessment of my mother having a typical autonomic nervous system disorder is indeed correct.
Could you please explain why my mother experiences autonomic nervous system dysregulation upon waking up? Is it triggered by a change in posture, or could it be due to other underlying issues?
Q2.
Regarding medication, we currently have "Labtal (Labetalol) 200 mg" and "Diovan (Valsartan) 160 mg" at home.
My mother believes that since the label on "Labtal" states "take as needed," it may be too potent and that taking too much could harm her health, while "Diovan" is relatively milder.
Could you clarify whether "Labtal" is indeed stronger than "Diovan," and if taking too much could be harmful?
Q3.
Following up on the previous question, my mother and I have differing opinions on the medication regimen.
My mother's planned approach is to take half a tablet of "Diovan" at 8 PM and then take half a tablet of "Labtal" in the morning based on her physical condition.
In contrast, I suggest completely replacing "Diovan" with "Labtal," so that my mother takes half a tablet of "Labtal" directly upon waking without considering her symptoms, to help regulate her autonomic nervous system and blood pressure.
In your opinion, which approach would be more suitable for my mother?
Q4.
May I ask if "Labtal (Labetalol) 200 mg" can be taken before bedtime? My mother is concerned that her blood pressure is generally lower during sleep, and taking "Labtal" before bed might lower it even further.
Therefore, she believes it is more appropriate to take "Labtal" in the morning.
Is her reasoning correct, or is it acceptable to take "Labtal" before bedtime as well?
Thank you, Dr.
He.

Axiang, 40~49 year old female. Ask Date: 2023/05/07

Dr. He Dongjin reply Cardiology

Hello,
Q1: There are many causes of autonomic nervous system disorders, and it is difficult to pinpoint the exact reason.

Q2: Taking medication when necessary does not mean it is stronger or harmful to the body.
Generally, the strengths of Amlodipine (referred to as "压血泰") and Diltiazem (referred to as "得安穩") are quite similar.
Diltiazem is not necessarily milder; it is safe for pregnant women to take Amlodipine, so the side effects are indeed low.
There is no issue of harming the body if not taken excessively.

Q3 & Q4: In fact, it can be taken in various ways.
You should take it in a manner that feels comfortable and provides stability.
Amlodipine can be taken before bed or in the morning, or you can take half a tablet of Diltiazem (0.5) at night and half a tablet of Amlodipine (0.5) in the morning.
The method of taking it is just a means to achieve stability and comfort.

Changhua Hospital cares about you.

Reply Date: 2023/05/07

More Info

Managing morning blood pressure and heart rate, especially in elderly patients, is a nuanced issue that requires careful consideration of various factors, including medication, physiological changes, and lifestyle. Let's address your questions one by one, providing insights based on medical knowledge.

Q1: Why does your mother experience autonomic nervous system dysregulation in the morning?
The phenomenon of increased heart rate and elevated blood pressure upon waking can be attributed to several factors. One significant factor is the body's natural circadian rhythm, which influences hormonal levels and autonomic nervous system activity. Upon waking, there is a surge in catecholamines (like adrenaline), which can lead to increased heart rate and blood pressure. Additionally, postural changes from lying down to standing can trigger orthostatic responses, causing fluctuations in blood pressure and heart rate. In older adults, these responses may be exaggerated due to age-related changes in the cardiovascular system and autonomic regulation.
Moreover, stress, anxiety, and even sleep quality can impact the autonomic nervous system. If your mother experiences anxiety or poor sleep, it could exacerbate these symptoms. It’s essential to monitor her overall health, including her mental well-being, as these factors can significantly influence her cardiovascular status.

Q2: Comparing the efficacy of Labtal (Labetalol) and Diovan (Valsartan)
Labtal (Labetalol) is a combined alpha and beta-blocker, which means it can effectively lower blood pressure by reducing heart rate and dilating blood vessels. Diovan (Valsartan), on the other hand, is an angiotensin receptor blocker (ARB) that primarily works by relaxing blood vessels to lower blood pressure.
In terms of potency, Labetalol can have a more immediate and pronounced effect on blood pressure, especially in acute situations, which is why it may be perceived as "stronger." However, both medications have their place in managing hypertension, and the choice between them often depends on the patient's specific health profile and response to treatment. It’s crucial to follow the prescribing physician's guidance regarding dosages and potential side effects.

Q3: Medication administration strategies
Your mother’s approach of taking half a tablet of Diovan in the evening and half a tablet of Labtal in the morning based on her symptoms is reasonable, especially if she is concerned about potential side effects. However, your suggestion to replace Diovan entirely with Labtal may not be advisable without consulting her healthcare provider.
The best approach often involves a combination of both medications, as they work through different mechanisms. It’s essential to maintain a consistent medication regimen to avoid fluctuations in blood pressure. If your mother experiences significant morning hypertension, it may be beneficial to discuss with her physician the possibility of adjusting her medication schedule or dosages to better manage her morning symptoms.

Q4: Timing of Labtal administration
Regarding the timing of Labtal, it is generally safe to take it at night, but this should be done with caution. If taken before bed, there is a potential for blood pressure to drop too low during the night or upon waking, especially if she has a history of orthostatic hypotension. However, if her morning blood pressure is consistently high, taking Labtal in the morning may be more beneficial for immediate control.

Ultimately, the decision on when to take Labtal should be made in consultation with her healthcare provider, considering her overall health status, blood pressure patterns, and any other medications she may be taking.

Conclusion
In summary, managing your mother’s morning blood pressure and heart rate involves understanding the physiological changes that occur upon waking, the effects of her medications, and the importance of a consistent medication regimen. It’s crucial to maintain open communication with her healthcare provider to tailor her treatment plan to her specific needs. Regular monitoring of her blood pressure and heart rate, along with a comprehensive approach to her overall health, will help ensure optimal management of her condition.

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