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Ask the doctor: Is my blood pressure too high in the morning?

Ask the doctor

Is my blood pressure too high in the morning?

Q. When I get up in the morning, my systolic blood pressure is 30 to 50 points higher than it is later in the day (about 110). I am taking three different blood pressure medications. Is this unusual?

A. Blood pressure is often highest in the morning, even in people who don’t have high blood pressure. Long before you wake up, your body starts boosting your blood pressure. That’s so there’s adequate blood flow through your 60,000 or so miles of blood vessels when you finally get out of bed.

That said, the difference between your morning and “usual” blood pressures is larger than normal. This suggests that some of your medicines are wearing off while you sleep. A number of blood pressure medicines are broken down and eliminated slowly, so some remains even after a good night’s sleep. Others are metabolized faster, and may be completely gone by the middle of the night.

Try keeping a record of your blood pressure over the course of several days. Write down the time of day, your pulse, and your systolic (the top number of a blood pressure reading) and diastolic (the bottom number) blood pressure. Do this before you get out of bed, during the morning, afternoon, evening, and before bed. At the same time, write down when you take your medicines. (To make it easier to see a pattern, try not to vary the time of day that you take them.) Talk with your doctor about any patterns you see. A simple change in dosing or a switch to a different, possibly longer-lasting medicine should solve the problem.

— Richard Lee, M.D. Associate Editor, Harvard Heart Letter

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Last updated:	October 01, 2006