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Dr. Andrew Rynne

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Does high BP stabilize during the nighttime?

Answered by
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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1707 Questions

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Posted on Fri, 8 Jun 2018 in Hypertension and Heart Disease
Question: I'm a 57 year old woman. I was diagnosed with high bp in 20I1 (due to stress of divorce) and was prescribed 25 mg Angisar (Losartan) to be taken in the morning.

It worked, however in 2016, (due to stress of son entering uni overseas) my bp shot-up and was prescribed 25 mg to be taken at night too.

I started taking both 25 mg doses (50 mg) in the morning on an empty stomach. I have since travelled overseas several times with no issues.

I would like to know:

1) If it is correct to take both 25 mg doses adding-up to 50 mg once in the morning on an empty stomach?

2) What is the point of breaking the dose to 25 mg in the morning and 25 mg at night?

3) Does the bp become normal as we sleep at night and so rested?

4) If Angisar ((Losartan) is safe and whether there are any adverse side effects?

5) What is the safest high bp med in regard to least adverse side effects like cancer, etc - Angiotensin 2 Receptor Blockers or Beta Blockers, Calcium Channel Blockers, etc?

Thank you
doctor
Answered by Dr. Sagar Makode 1 hour later
Brief Answer:
Yes, 50 mg once can be taken

Detailed Answer:
Hello,
There is no need to break the the medicine in two doses and can be taken at once in the morning as it's a long acting medicine. It is prescribed in the single daily dosing only. This can be taken with or without food, there is no issue regarding this.
Bp does not normalize completely during sleep but in most of the individuals it's slightly lower during the sleep than awake state. Exact behavior of bp during the night can be studied by 24 hour ambulatory bp monitoring.
Losartan is safe and be taken on long term. Calcium channel blockers are also safe. Every medicine has got some side effects but since you have tolerated it well so less likely to develop any new side effects now. You should get your renal function test and potassium levels done once while on this medicine if not checked. So I think it's better to continue the same medicine, 50 mg in the morning. There is no increased evidence of cancer with either medicine.
Hope this helps you and get back if you have any doubts.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sagar Makode 3 hours later
I would like to know:

1) If 50 mg of Angisar (Losartan) is a very high dose with the potential to cause serious side effects?

2) If I can lower dose to 25 mg (like it was prior to 2016)?

3) If it is safe to travel on long-haul flights (13 hours after connecting from 5 hours)?

4) If it's wise to take Aspirin on long-haul flights to avoid DVT after taking Angisar (Losartan)?

5) Any new drug that's better than Angisar (Losartan) with fewer or no side effects?

Thank you
doctor
Answered by Dr. Sagar Makode 3 hours later
Brief Answer:
Its a moderate dose of losartan

Detailed Answer:
25 mg is the lowest dose and 100 is highest, 50 mg is average and most commonly used dose. So you need this much dose to control your bp then you should have it. Its a very and commonly used drug for hypertension, and I don't see any reason to change it to another drug. So you can safely continue it.
How are your current bp readings, if they are in lower range we can try reducing the dose to 25 mg and if readings are not very good then you should continue the same.
There is no harm in traveling with losartan. Also, efficacy of aspirin in long haul travel is not well proven, but since the dose of aspirin is very low, half baby aspirin(81 mg), there is no harm in having it and you can take it.
All the best.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Sagar Makode 8 hours later
Thank you for answering.

I would also like to know:

1) Why the right part of the back of my head above the neck sometimes throbs with slight pain especially if I break rest? I was told that pain in the back of the head indicates high bp?

2) If living in cold weather especially during Winter with temperatures well below zero is dangerous for people with high bp. I was told that high altitudes are dangerous for people with high bp?

3) Whether drinking alcohol (in moderation) at social functions is bad for high bp? How much alcohol can a person with high bp consume or should alcohol be given-up completely
doctor
Answered by Dr. Sagar Makode 12 minutes later
Brief Answer:
Headache not always suggestive of high bp

Detailed Answer:
High bp usually above 170-180 may cause some symptoms like headache, dizziness, but headache doesn't imply high bp only. It has got multiple reasons, incomplete rest or sleep, stress which is most common cause, sometimes spine problem due to nerve compression etc etc. So every doesn't mean high bp.
Next, cold weather cause peripheral vasoconstriction and can raise bp to some extent but doesn't means it very dangerous and cold exposure should be avoided altogether which is not possible. So bp may rise marginally in very cold weather.
Alcohol in moderation is acceptable. Upto a drink a day (12 gm per day, nearly 300 ml beer, nearly 25-30 ml of whiskey etc) is acceptable for females, so try to restrict below it. So try to keep it as low as possible.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sagar Makode 3 hours later
Thank you for answering.

You didn't answer my question on altitude - whether high altitudes increase high bp?

I would like to ask what I should Ido, take, etc in cold Winter weather with temperatures below zero?
doctor
Answered by Dr. Sagar Makode 4 hours later
Brief Answer:
No significant effect of altitude on bp

Detailed Answer:
There is no significant effect of altitude over the bp. High altitude can cause other problems like pulmonary edema, bleeding from nose etc, but is not affected much.
You don't need to do any specific things in cold. Just need to monitor the bp and general measures for protection for cold.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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