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Dr Basu
Dr Basu, Experienced Specialist
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My mother has high blood pressure but only at night. When

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My mother has high blood pressure but only at night. When she lays down to sleep at night, her blood pressure goes up. She also has popping in her ears. She is on high blood pressure medication but it doesn't seem to work at night. In the morning when she gets up, it is usually around 180-190. Can you think of what the cause of this might be?
mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

mysticdoc :

Hello,

mysticdoc :

Thanks for your question .

mysticdoc :

what medications your mother are on now?

mysticdoc :

when does she take the medications?

Customer:

Let me ask her. I know she takes it at night before she goes to bed. She's not picking up. Sorry

mysticdoc :

ok

Customer:

She was taking it in the morning and the doctor changed it to night in hopes it would help better.

mysticdoc :

does she get any headaches or shortness of breath?

Customer:

No

mysticdoc :

ok

mysticdoc :

in elderly people, the blood pressure may remain falsely high.

Customer:

She said she wakes up at night with heavy sweating.

mysticdoc :

That is why blood pressure should be checked both at sitting and standing positions.

mysticdoc :

ok.

mysticdoc :

that can be medication related side effect as well.

Customer:

What do you mean by falsely high?

mysticdoc :

Due to the hardening of the arteries, the BP cuff does not compress the artery well and gives falsely high BP reading.

Customer:

Okay

mysticdoc :

does she feel dizzy on standing up?

Customer:

Sometimes, yes

mysticdoc :

ok that suggests that actually her Bp may not be as high as it is being measured.

mysticdoc :

On standing blood pressure drops and even more with medications causing dizziness.

Customer:

Is there a better blood pressure monitor she can get that is more accurate?

mysticdoc :

That is why Bp should be measured in both positions sitting and standing to see any significant differnces

mysticdoc :

Intra arterial BP measurement is accurate but that can only be performed by the doctor as it requires putting needle inside the arteries.

mysticdoc :

This is not usually required as long as her BP is not too low on standing.

mysticdoc :

Also certaing maneuvers like palpating the radial or brachial artery when there is no blood flow on inflating the cuff helps to see if the ahardened arteries causing the false BP measurement.

Customer:

Where is the radial or brachial artery at?

mysticdoc :

brachial at the forearm, radial at the wrist.

Customer:

Do all old people have hardening of the arteries?

Customer:

The medication she takes is Ramipril. 5 ml tablet and 2.5 tablet daily at night

Customer:

Are you there?

Customer:

Okay, I guess I'm signing out now

mysticdoc :

ok i am back

mysticdoc :

yes most elderly people have this s problem.

Customer:

Okay

Customer:

Is this something she wouuld have been diagnosed with?

mysticdoc :

now she is only on one medication for blood pressure control.

Customer:

yes

mysticdoc :

Currently we advise more than one medication in case BP is genuinely high.

Customer:

What should she tell her doctor?

mysticdoc :

Please print out the chat and show her doctor.

Customer:

okay

mysticdoc :

In case the BP is still high, then a diuretic like hydrochlorothiazide can be added at bedtime.

mysticdoc :

This is in addition to ramipril.

Customer:

Okay

mysticdoc :

Best wishes,

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