Your situation is different, because you haven't been taking the med for too long.

In hospitals, they are very strict about times.

Daily = 9am by me. Bedtime = 2200.

All meds are given around those times. Period. Unless the MD wants a specific dose.

However, if the patient comes in at let's say 9 pm , the MD may want a dose now, and then start the regular dosing at 9 am also.

Not so much. Especially since it is so close to 8 am. 2 pm isn't to far off.

By all means, if you feel more comfortable dosing 1:30PM, 1 PM, etc. That is fine.

However, from a clinical stand point, the drug isn't even at "steady state" in your body yet, so the quicker the better you change it.

You may even try to take it at 10 AM tomorrow, then 8 am the next day. It really is up to you. But I think whichever way you do decide to go, you will be fine. :)

Yes very constant.

Sometimes people miss a dose, it happens. General instructions for those are NEVER double up on a dose, just take it as soon as you remember.

Do you take any other medication?

No problem

I was disconnected sorry

You can take Micardis with or without food

If you do take thyroid medication, you shouldn't take this med with food

See how it feels before breakfast, it really doesn't have too much effect on the stomach. Everyone is different though.

It isn't like, for instance Naproxen, that is better to take with food

Are you still in the chat?

Just want to make sure I am not having problems

Ah ok good.

Also, how much salt intake are you consuming?

People generally say no more than 2.3 grams of sodium/day

But a little less I think is better. Sodium can raise BP significantly

That is usually the guidelines, 2.3grams a day.

Good. perfect.

Also it may take a little bit for you to see an effect.

You want that BP to come down quite a bit. 160/90 = Stage 2 hypertension. The doctor may want add another drug in the future just in case it doesn't come down fully

It depends, sometimes a month is sufficient.

Yes, I agree, the earlier the better, and always on time.

It isn't going to be terrible if you are off by an hour or two, it will be OK

but always try to remain on schedule.

Let me link you to some other steps you can do to lower your BP

Some non drug options

Not so much, the thing with Micardis is that it lasts 24 hours.

Some other blood pressure medication must be dosed twice a day, or three times a day.

See, the problem with those drugs, such as clonidine, is the risk of rebound hypertension

Those who have to be worried about that effect the most.

Clonidine is a very potent dilator. The route it works is different from other medication.

When the body doesn't have clonidine , or a dose is skipped, blood pressure spikes.

Therefore the medication has to be withdrawn very slowly.

Beta blockers, such as Coreg have this effect, and are usually dosed twice a day.

Most blood pressure medications- Yes, you have to decrease very slowly

But Micardis lasts 24 hours, therefore, a few hours of missing the medication will not be so detrimental

If a patient doesn't have clonidine for a few hours, his/her pressure may skyrockert, because it is so short acting.

Skyrocket*

I have some good hypertension information too, let me see if I can dig it up

Yup I am going to give you some information.

A BP 160/90 , however, needs to be treated promptly with medication.

Are you familiar with Adobe Acrobat reader? AKA PDF files?

I am sorry to here about that.

Trust me, I've had stress related BP issues myself , it really stinks. My BP is still high, I really need to make lifestyle changes myself.

Let me fetch this link, then we can discuss it a little bit, how does that sound?

http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

This is the motherload for all blood pressure lowering guidelines

Go to page 26

Read that little chart, and let me know when you are done, so we can discuss

JNC 7 = The guidelines for hypertension

It is what clinicians use as a handbook.

I have a little extra information on those things in the chart I can explain

So as you can see, it really isn't a myth that alcohol is good for you.

In moderation, it is actually part of the plan to lower BP.

Weight loss, in my opinion, is the most important thing here.

Are you overweight?

Wise..

Good.. Yes you will see quite a change.

If you drink soda, stop drinking it and replace it with water

In school, we were learning about studies being performed about people stopping soda intake.. and I remember one study, patients had lost on average 13 pounds.

Ok good, that's awesome.

Yes, insane right?

I used to be a cross country runner myself.. Then as soon I stopped running I gained so much weight.

I drank a LOT of soda in college

Up late.. Grab a red bull.. Or some Pepsi..

It all adds up. I stacked on the pounds nonetheless.

It really does help though. Just that alone is so vital .

You saw the part about the DASH diet right? That is another key element. I know you hear it all the time on television, from doctors etc..

But it is true.. Diet and exercise is very important.

Just by doing those things alone, will drop your BP. If you get to a normal BMI (Body mass index ) you'll see your pressure will come down too. Sodium intake reduction helps a LOT too

That is the motherload. I don't let my customers down. :)

What about stress management? How are you with stress?

Yes, for the most part I can give you the names of major guidelines

The studies are a little tougher for the general public to find.

However, the actual "Gold"standards are easy to find

ATP III is for cholesterol. GOLD guidelines is for asthma/COPD. JNC 7 ( JNC 8 is coming out this year) is for high BP

You have to manage stress. I can get stressed easily. I work two jobs, late hours. I have to really start putting an exercise plan in motion myself. It helps out a lot.

I've just been exhausted with family issues and work. But for now XBox makes me happy lol...

Also, I've taken on gardening.

Not only do you learn a lot about the plants, but also, the stuff you grow can be awesome health wise.

Last year I grew a lot of lettuce, peas, corn, brussel sprouts..

Computer science is awesome. I've been trying to teach myself Javascript as of late. It is amazing. iOS is where the money seems to be at. So objective C will have to be something I will learn.

Again, these are all things you must enjoy .

They certainly help destress myself. Stress is very detrimental to the body.. So is lack of sleep.

So you have to find a niche, something you really like. You'd be surprised how much it helps.

I always wanted to learn any time C based language, just never had time. My schedule has been easing up a bit, so I've been learning JS for now. I love it. Feels good to learn something.. The sense of accomplish certainly helps.

If you look at that chart ,on page 26, you can see just by lifestyle changes alone, for some people, can change a LOT

For a baseline pressure of 160/90, it may/may not be affected solely by lifestyle alone. I'd want to see you on Micardis to be honest until you have the pressure come down a bit

Micardis, and the class of medications, are great drugs.

Not too many side effects, lots of mortality/morbidity changing things that are associated with the drugs.

Preserve kidney function, great for Heart failure patients, etc.

And you very well may be able to.

Key things- Weight loss, Sodium reduction, stress reduction.

Work on those, and I promise you, you'll see a difference.

I know, especially in the US it is hard to eat right. especially when you are on a busy schedule

But once it becomes routine, it is a lot easier.

Do you need help with anything else friend? Any other questions?

Oh for sure. fast food is an epidemic .

Have I answered all the questions you had?

Great bud. Def read over the JNC-7 guidelines.

It has a lot of useful information. In the future, if you need any studies pulled or any other guidelines, shoot me a line .

Great, am happy to help.

If you are satisfied click accept. If you have any last minute questions, be sure to click reply before accepting .

I hope you have a great night. And like I said, don't worry too much about the Micardis. One day starting at 8 am tomorrow is fine. It will take about 5 days for that drug to build up completely in your body. So you are fine. :)

Steady state = 5 X Half life of drug ( in this case, micardis is ~ 24 hour duration ) = 5 days

You too . I'll be here if you need anything else. Enjoy your night . :)