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My father's blood pressure fluctuates greatly. In the early

My father's blood pressure fluctuates...
My father's blood pressure fluctuates greatly. In the early morning it goes as high as 170/100 and at night it goes as low as 80/40. He is on Diovan 360 mg taken at 7 am, and Carvedilol 25 mg taken 7 AM and 7 PM (50 mg total). He pressure was doing great but recently his work stress has increased so his daytime readings are high. I read that calcium channel blockers work well with BP that varies to widely. What would you recommend here? He had a heart attack this year and received a stent. He got lucky and his EF is 55% and everything is good. Things were under control until recently. I worry about a stroke with him on blood thinners.
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8/22/2017
Dr Uzair
Dr Uzair, Doctor
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Calcium channel blockers a good choice but have side effects like electrolyte imbalances and fluid retention. He is currently on a ACE inhibitor and a beta blocker. It should be best to ask his cardiologist to put him on an ARB - angiotensin receptor blocker which are better controllers of blood pressure and can be divided in to two doses for AM and PM.

The increasing stress and decreasing effectiveness of the ACE inhibitor as the day goes on - raises his blood pressure and then the Beta blocker in the evenings tends to have a bounce back effect causing it to fall down again. He is on a high dose of the beta blocker which should be reduced to just the AM dose.
Fluctuations are not healthy and for someone on blood thinners, your concern is genuine.

I would suggest that you have him see his cardiologist for a dose adjustment and substitution of the Diovan with an ARB like candesartan or losartan.

Hope this helps.
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Customer reply replied 3 months ago
Are ARB's safe for someone who has had a heart attack?

Yes, they are safe and effective in treating coronary artery disease.

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Have a good one!

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Customer reply replied 3 months ago
How come when I look it up it tells me Diovan is an ARB and not an ace inhibitor?

Yes, you are right. My apologies, he is already on an ARB.

Which means that his doctor has already started him on one.

There aren't very many cases of blood pressure fluctuations with ARBs, so it is more likely the Beta blocker that is causing the fluctuations. So, decreasing the dose of the beta blocker and gradually replacing it with an added diuretic along with the ARB will be a better alternative at this point in time.

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Customer reply replied 3 months ago
What do you think the best time of day is for him to take the 360 mg of Diovan?

It is best to take the ARB after he wakes up in the morning because he is on a once daily dose. For individuals who are twice daily dose. One is taken in the morning after a person wakes up and the other is taken in the evening so they are almost 12 hours apart.

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Customer reply replied 3 months ago
Do you think we should ask the doc to space them out into 2 doses instead of 1 or does it not matter?

Yes, that is what I recommend too, 360 mg is a high dose to be taken at one time, so dividing it will be a better option.

Hope this helps.
Please do leave a positive rating for the service by clicking on the stars on top of the screen.

Best wishes.

Dr Uzair
Dr Uzair, Doctor
Category: Medical
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Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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Customer reply replied 3 months ago
Thank you

Pleasure to have been helpful.

Take care.

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