If you have such a problem, the first thing to think about is whether or not you have taken your medication as prescribed by your doctor. Recently, I met a patient who was in such a situation, let's call him Lao Zhang for the time being. He had high blood pressure, and the doctor prescribed him nifedipine tablets, telling him to take one tablet a day (10mg) three times a day. At the beginning, he adhered well to the dosage. One day, when he was chatting with his neighbor, the neighbor said that he also took nifedipine, once a day. Old Zhang thought that his blood pressure was under good control recently, and it was too troublesome to take it three times a day, so he changed it to once a day, one tablet at a time. As a result, within a few days, he was hospitalized again because of high blood pressure. The same medicine, why some take it three times a day, some take it once a day. We also take nifedipine as an example, Lao Zhang ate nifedipine tablets, this ordinary tablets orally 1-2 hours after the effect of the peak, the effect lasts 4-8 hours, so this drug needs to be eaten three times a day in order to effectively control the whole day's blood pressure. It's not surprising that when Lao Zhang takes one tablet in the morning, in the afternoon or at night, the effect of the drug is gone and his blood pressure rises. As for Lao Zhang's neighbor, although he is also taking nifedipine, he is taking nifedipine controlled-release tablets. Controlled-release tablets are a special type of drug dosage form, in which the drug can be released at an approximately constant rate within 24 hours, and the duration of action can be maintained for one day, so it is enough for him to take the drug once a day. Therefore, in order to achieve a good therapeutic effect, we must follow the doctor's instructions to take medication, do not hearsay arbitrarily change the method of taking medication.

Blood pressure has a circadian rhythm of change, most people a day 24 hours of blood pressure rhythm is, with the morning wake up and rise, daytime continues to be in a higher state; night blood pressure gradually decline, in the process of sleep down to the lowest, 2-3 points at night for the lowest valley, so antihypertensive drugs are generally taken in the morning. However, there are exceptions, about 10% of hypertensive patients with normal blood pressure during the day, simple nighttime hypertension, such patients need to take medication before bedtime. Simple nocturnal hypertension is a kind of hidden high blood pressure, need to do dynamic blood pressure to confirm the diagnosis, if you follow the doctor's instructions to take medication according to the dosage, but still often at night blood pressure control is not good, then it is recommended that you go to see a doctor for further diagnosis.

In addition, if you are monitoring your blood pressure at home, you should also pay attention to whether you are measuring your blood pressure in the right way. We need to remind you that we can not measure nighttime blood pressure at home. Some patients, in order to get nighttime blood pressure, set alarms to get up in the middle of the night to measure blood pressure, or get up at night to measure blood pressure when they wake up, and this kind of blood pressure value measured by destroying the physiological state at night is not representative of the nighttime blood pressure. If you want to monitor nighttime blood pressure, you can go to the hospital to do 24-hour ambulatory blood pressure. It should also be noted that the number of blood pressure measurements should not be too frequent, some people want to get up and measure, easy to produce anxiety, it is recommended to measure once a day in the morning and evening, preferably in the morning after getting up to urinate, before taking medication, and at night before going to bed, and consecutively measured for seven days. If a certain blood pressure value is not normal, do not be overly concerned, because blood pressure is affected by the internal and external environment has a certain degree of fluctuation.

We also need to remind you that, for patients with hypertension, in addition to taking medication on time and in accordance with the amount, but also pay attention to change the unhealthy lifestyle, many patients take 2 or 3 antihypertensive drugs, blood pressure is still poorly controlled, is because of the treatment at the same time but also ate too salty, excessive drinking, eating and drinking, no exercise, lifestyle and unhealthy, leading to antihypertensive drugs ineffective. Improvement of lifestyle is the foundation, rational use of medication is the key to achieve the blood pressure standard, the two must be properly combined in order to effectively control high blood pressure.

Ref: Hypertension Alliance (China), National Center for Cardiovascular Disease, et al. Guidelines for educating hypertensive patients in China, Chinese Journal of Frontiers of Medicine (electronic version), 2014, 6(3):78-110.

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What happens when a patient with high blood pressure takes his medication in the morning and then gets high again in the evening? This question is asked a lot, at the same time in the clinic to see a lot, so that is very common, Dr. Zhang today specially to explain to you.

In real life, there are many hypertensive patients encountered this similar situation: the morning took antihypertensive drugs, the evening blood pressure is high again, as if the antihypertensive drugs in vain. So, how should we face this kind of problem? In fact, this situation may have the following two reasons:

First, this kind of high blood pressure patients eat a short-acting or intermediate-acting antihypertensive drugs, this kind of antihypertensive drugs eat into the effect of time can be maintained for 4-8 hours. If the hypertensive patient is to take drugs in the morning, then in the afternoon or evening it is likely that the effectiveness of these antihypertensive drugs disappeared, and then the patient's original elevated blood pressure will be revealed, resulting in the opening paragraph mentioned the problem of high blood pressure at night again.

My recommendation for this situation is to discontinue short- and intermediate-acting antihypertensive medications and switch to long-acting antihypertensive medications, as well as monitor your blood pressure at night.

Second, there is also a situation where the patient is also taking long-acting antihypertensive drugs, such as amlodipine, these long-acting antihypertensive drugs, but at night the blood pressure will also rise. This time may be attributed to the patient's unstable blood pressure fluctuations, may not fluctuate throughout the day blood pressure, take antihypertensive drugs can be controlled, but the patient to the night because of a variety of reasons at this time the elevated blood pressure can not be controlled, fluctuations, which is also relatively common.

In this case, my recommendation is to add an antihypertensive medication 1-2 hours before the nighttime increase in blood pressure. The purpose of this is to increase the strength of the antihypertensive medication to depress the nighttime increase in blood pressure. Alternatively, some patients may be able to take the original oral antihypertensive medication 1-2 hours before the nighttime increase in blood pressure, using the peak period of the medication to lower the nighttime increase in blood pressure.

In short, for those patients who took antihypertensive drugs in the morning, to the evening blood pressure is high again, each patient has their own specific circumstances, each person with each person is also really different, if you encountered, be sure to formal consultation, under the guidance of a professional doctor to carry out the relevant treatments and medication adjustments.

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Meeting the standard for hypertension control requires adherence to long-term, smooth, and effective blood pressure control. To put it simply, it requires that blood pressure be reduced to normal and that it does not change much over a 24-hour period.

High blood pressure in the evening after taking medication in the morning is definitely inappropriate, and there are possible reasons for this:

(1) Is the antihypertensive medication taken long-acting, intermediate-acting, or short-acting?

Long-acting drugs, can be taken once a day, the effect can basically be maintained for about 24 hours, effective control of nighttime blood pressure and morning peak blood pressure, more effective prevention of cardiovascular and cerebrovascular complications. Medium-acting or short-acting medication is taken 2 to 3 times a day to achieve balance throughout the day. If the medication is taken only in the morning and not in the evening, there is no longer any medication effect, and the blood pressure will definitely rise.

Hypertension is a condition in which arterial blood pressurepersistent elevationProgressive disease characterized. Therefore, it is recommended that long-acting antihypertensive drugs be chosen as much as possible, and if medium- or short-acting preparations are used, they need to be administered two to three times a day.

(2) Inaccuracy of measurements

① Measure your blood pressure at a fixed time every day; ② You can choose more time points, once in the evening, once at noon and once in the evening; ③ Sit down and rest for at least 5 minutes before measurement, and the resting time can be prolonged after a strenuous exercise; ④ Don't eat before the measurement; ⑤ Measure for several days and calculate the average value to exclude the influence of certain factors.

(3) Characteristics of its own blood pressure

Each person's blood pressure characteristics are different, most people have low blood pressure at night, but some people with evening or early morning blood pressure increased, it is recommended to carefully choose to adjust the time of medication or evening carefully add drugs according to the doctor's advice.

(4) Unreasonable lifestyle

Lifestyle adjustment is the basis of blood pressure control, throughout the whole blood pressure reduction, not only can prevent and delay the occurrence of hypertension, but also reduce blood pressure, improve drug efficacy and reduce cardiovascular risk. Such as quitting smoking and drinking, low-salt and low-fat diet, proper exercise, weight control, reducing mental stress and maintaining psychological balance.

So, first conduct a cause analysis, take several blood pressure measurements and record them before asking your doctor for proper advice.

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First of all, please take out the boxes of the antihypertensive pills you take and compare them to what I said below and you will know the answer.

I. Characteristics of the onset of action of various types of antihypertensive drugs

The first category is diuretics: commonly used are hydrochlorothiazide, spironolactone, indapamide and so on. This type of antihypertensive to have a smooth, slow onset of action, but the duration is relatively long, the effect is long-lasting, and the effect reaches its peak after 2-3 weeks of taking the drug.

The second category is beta-blockers: commonly used are metoprolol (betalactam) and bisoprolol. This class of antihypertensive to have a rapid and powerful onset of action, the duration of which varies.

The third type is calcium antagonist: commonly used are nifedipine, nifedipine controlled release tablets (baisinomide), diltiazem, etc.. This type of antihypertensive to the rapid onset of action, antihypertensive efficacy and antihypertensive amplitude is relatively strong, short-term treatment can generally reduce blood pressure 10%-15%, the dose and efficacy of the positive correlation, and other types of antihypertensive drugs with the combination of treatment can significantly enhance the role of antihypertensive.

The fourth category is angiotensin-converting enzyme inhibitors: commonly used are perindopril, benazepril, enalapril and so on. This type of antihypertensive to start slowly, gradually enhance, in 3-4 weeks to reach the maximum effect.

The fifth category is angiotensin II receptor blockers: commonly used are valsartan and irbesartan drugs. This type of antihypertensive to start slowly, but durable and smooth, usually in 6-8 weeks to reach the maximum effect, the duration of action can reach more than 24 hours.

II. Dosage of drugs commonly used in the five classes of antihypertensive drugs. (as shown below)

From the point of view of the above chart, most of the antihypertensive drugs are 1 time a day, some antihypertensive drugs when 2 times or 2-3 times, this is the type of antihypertensive drugs onset of action and duration of the characteristics of the decision, so patients with high blood pressure in the morning and then high in the evening, it is possible that they are taking the type of antihypertensive drugs that have a rapid onset of action but do not last long.

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Many friends with high blood pressure problems, the doctor's advice early in the morning after waking up to take medication, this is because, after waking up in the morning, due to the sympathetic nerve excitation, heart rate accelerated and other aspects of the impact, usually lead to the emergence of a peak blood pressure, morning after waking up to take medication is usually for the morning peak of high blood pressure control has a better effect. However, some friends found that after waking up in the morning to take medication, to the evening measurement of blood pressure, blood pressure is high again, what is the reason for this?

Usually for antihypertensive drugs, the drug is different, after taking to play the effect of lowering blood pressure, the duration of the drug in the body is also different, if you take the short-acting drugs or medium-acting drugs, can not be in a day to smooth the control of blood pressure, then there may be such a morning after taking the drug, the evening blood pressure rise.

To give an example of a common drug that we use, say nifedipine extended-release tablets, there are three types of this drug, which will be identified on the drug name (I) (Ⅱ(Ⅲ), in which nifedipine extended-release tablets 3 action time can last 24 hours, but the extended-release tablets 1 and 2 of its antihypertensive effect can only be maintained for 12 hours, therefore, for some friends with high blood pressure, early in the morning ate nifedipine extended-release tablets 2, to the evening, the drug has been released, basically no control of blood pressure, at this time, if you measure the blood pressure, blood pressure may appear to be elevated. At this time, taking another tablet in the afternoon or evening will enable better and smoother control of blood pressure.

Of course, there are still some friends whose blood pressure is not high in the evening and can be kept stable even without taking an additional dose of medication, in which case there is no need to take an additional dose of medication in the evening. Usually, we recommend hypertensive patients to control their blood pressure by giving priority to long-acting preparations that can work all the time within 24 hours, also to avoid the problem of blood pressure fluctuation in the evening after taking the medication in the morning.

In addition to the problems of taking medication, hypertensive patients should also pay attention to their own blood pressure fluctuations, although we say that morning peak hypertension is very common, but there are also many hypertensive patients friends, their blood pressure fluctuation law does not present early morning and afternoon two peak hours, evening and night blood pressure decrease in regularity, and there are even some friends, the peak of the blood pressure occurs in the evening, but it is also possible. For this situation, after taking the drug in the morning, the early morning itself is not the peak blood pressure, to the peak of blood pressure in the evening, there may still be a rise in blood pressure, for this situation, adjust the time of medication, in the peak of blood pressure 2~3 hours before the medication, for the peak of blood pressure control is generally better, if you are taking a long-acting drugs, change the time of medication, there is still a rise in blood pressure in the evening, the case of blood pressure. If you are taking a long-acting drug and change the time of administration, and still experience an increase in blood pressure in the evening, then it is a good choice to apply other drugs in combination to assist in controlling blood pressure.

Of course, there are a variety of hypertensive patients, in some friends, control of blood pressure is very simple, but in some friends, control of blood pressure is really not easy, reasonable use of medication, blood pressure monitoring are very important aspects, for some geriatric hypertension, such as more than 80 years of age, or older, serious vascular sclerosis, if the blood pressure control is really not 140 For certain geriatric hypertension problems, such as those over 80 years old, or older people with severe vascular sclerosis, if the blood pressure cannot be controlled below 140, then it is also ideal to control the blood pressure below 150. It is very important to respond according to the specific situation, to choose the medication reasonably and the duration of the medication, and to pay attention to the life conditioning to keep the blood pressure relatively stable as long as the body is able to tolerate.

Hypertension takes medication in the morning and then gets higher at night, due to both medication and patient's own factors

The drug factor

The antihypertensive drugs taken are not long-acting preparations, which cannot maintain the antihypertensive effect for 24 hours. Therefore, if the antihypertensive drugs are taken in the morning, the antihypertensive drugs will have been metabolized by the evening, or the residual residue of the drugs will only be low, and the blood concentration will be too low, which will not be able to achieve a good antihypertensive effect. In this case, it is recommended to take long-acting preparations, at present, five categories of commonly used antihypertensive drugs, namely, angiotensin-converting enzyme inhibitors (Prilosec), angiotensin 2 receptor antagonists (sartans), calcium channel blockers (diphenhydramine), β-blockers (Lorazepam), thiazide diuretics (hydrochlorothiazide, etc., indapamide), each type of drug contains long-acting preparations, and the drug can be taken at night, or only low residual drug concentration is too low, can not achieve a good effect. The group Doppler in the Prilosec drugs, Timosartan in the sartans, Amlodipine in the diphenhydramine drugs, Nifedipine controlled-release tablets, Metoprolol succinate extended-release tablets, Bisoprolol in the beta-blockers, Indapamide in the diuretics, etc., either through their own long half-life of the drug, or through the process of controlled-release preparations, can play a long-lasting effect of lowering the blood pressure, once a day to take it can be.

Patient's own factors

Under normal circumstances, the human body's blood pressure changes show two peaks and one valley of the spoon curve, so it is also known as the ladle type blood pressure, two blood pressure peaks generally appear in the morning at 8:00 - 10:00 a.m., 16:00 - 18:00 p.m., and then the blood pressure gradually fall back to the lowest point of the whole day in the early morning at 2:00 to 3:00 a.m.. The blood pressure then gradually falls back to the lowest point of the whole day at 2:00 am to 3:00 am. Some hypertensive patients, such as most of the elderly and some young people who have high pressure in work and life, staying up late, mental tension and endocrine disorders, will lose this normal circadian rhythm, and the aryepiglottic curve will be deformed, manifesting itself as a non-aryepiglottic type, or even an anti-aryepiglottic type, which is characterized by the rise of blood pressure at night instead of falling, manifesting itself as nocturnal hypertension. There are also some disease factors such as sleep apnea caused by snoring at night, which is also one of the causes of nocturnal blood pressure increase. In addition, obesity, salt sensitivity, diabetes mellitus and chronic kidney disease are also sensitive to nocturnal hypertension.

The first thing to do is to look for the cause of elevated blood pressure at night. If it is caused by poor lifestyle, we should start from changing the lifestyle, such as regular work and rest time, changing the bad habit of staying up late, adjusting anxiety, etc. If it is caused by pathological factors, such as the presence of sleep apnea, we should start from the treatment of the disease. In terms of drug adjustment, under the premise of advocating the taking of long-acting antihypertensive drugs, you can change the taking time of the drugs from the morning to the evening, or on the basis of taking long-acting preparations, the evening with a short- and medium-acting varieties of antihypertensive drugs to control nighttime blood pressure

Finally, it is important to note that the diagnosis of nocturnal hypertension is not an easy task because blood pressure changes dynamically throughout the day, and this is also true of nocturnal blood pressure. 24-hour ambulatory blood pressure monitoring is the preferred method of evaluating nocturnal hypertension, which measures the average value of blood pressure from the time of falling asleep to waking up from 1:00 a.m. to 6:00 p.m. The criterion for elevated nocturnal blood pressure is ≥120/70 mmHg, and the criteria for elevated nocturnal blood pressure are ≥120/70 mmHg. 70mmHg,. Nocturnal hypertension is strongly associated with target organ damage and adverse cardiovascular events such as heart attack and stroke. Reducing nocturnal hypertension reduces cardiovascular risk.

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What happens when a patient with high blood pressure takes his medication in the morning and then gets high again in the evening? This is a good question, and it's a situation that many patients often encounter. Dr. Xu is here to analyze the reasons and tell you the appropriate solutions.

1. taking antihypertensive drugs that are medium- to long-acting.The half-life is not that long, it can't last 24 hours, so you need to take it twice a day. Nifedipine extended-release tablets such as Deconazole, Nifedipine, Metoprolol Tartrate, Captopril, etc. If this is the case, it is recommended to take an additional antihypertensive medication one hour before the blood pressure rises at night, because it takes some time for the medication to take effect, so take it one hour earlier.

2. The patient's blood pressure curve is "anti-spoon".Our blood pressure is not fixed, generally high during the day and low at night, like a spoon, we call it "spoon curve". However, the blood pressure of some hypertensive patients is not high during the day and is high at night, like a spoon placed in the opposite direction, which is called the "anti-spoon" curve. If this is the case, it is recommended that antihypertensive medication be adjusted to be taken at night, again one hour before the blood pressure rises.

3. taking a long-acting medication or getting high in the evening. This has to do with the pharmacokinetics of the drug.Because each person's absorption of the drug varies greatly, but also with the metabolism in the body. For example, the half-life of valsartan is 5-9 hours, it may be metabolized in half in 5 hours in your body, in his body is metabolized in half in 9 hours, so it is possible that this part of the patient with less absorption and fast metabolism will have a rapid decline in blood concentration, and the blood pressure will rise again at night. If this is the case, it is recommended to prefer to add other kinds of drugs at night, or to add the antihypertensive drugs taken in the morning again at night. It is also necessary to take the medication 1 hour before the blood pressure rises.

These are the reasons why you take your medication in the morning and your blood pressure rises again at night, is that clear?

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Patient Mr. Wang asked: Dr. Chen, I take one tablet of amlodipine and half tablet of metoprolol every day as you said above, and my blood pressure has been under good control, but recently, I don't know why, my blood pressure is down after taking the medicine in the morning, but once I measure my blood pressure in the evening, sometimes it reaches 150/100mmHg again, what may be the reason for this? How can I control my blood pressure?

Obviously, the problem encountered by the subject is very similar to a patient I once saw. Of course, Dr. Chen has not only encountered such a patient, in fact, this kind of problem is very common, and it is not uncommon to see blood pressure rise even after adhering to the medication!

Why is that?

There are many factors that can cause fluctuations in our blood pressure!

First.People's emotions will have an impact on our blood pressure, long-term mental stress will lead to our body's endocrine disorders, disorders, causing vasoconstriction, resulting in a sudden rise in blood pressure.Therefore, it is very important for people with high blood pressure to regulate their emotions in general, but this elevated blood pressure is often transient, which means that if you have elevated blood pressure at night caused by emotional factors, you will not have such high blood pressure every night!

Secondly.Previously, I had been taking only high blood pressure medication, and then as I got older or other factors, there were other medications that I was taking with it, which can actually have an effect on our blood pressure.Like the simplest example, if you have a cold and take some pseudoephedrine hydrochloride, you can take your blood pressure and it will definitely go up because it is a vasoconstrictor. Therefore, you can rule out whether you have recently added or taken any other drugs and eaten other foods.

Sure.And then there's the change of seasonsThis is well understood, the change of seasons, the temperature difference will make our body's blood vessel contraction or diastole, will have an impact on our blood pressure, so, our clinic will often require some of the hypertensive patients in the weather changes, adjust the dose of antihypertensive drugs, so as to maintain blood pressure stability!

Meanwhile.Then there are the hypertensive patients who had nothing else wrong with them before, and then had other illnesses that affected their blood pressure, for example, patients with high blood pressure who also have kidney stones, etc., can also have elevated blood pressure!

Lastly, and very importantly for all of you to note.That is, you may have previously had spoon-type hypertension that developed into non-spoon-type hypertension, and most normal people have spoon-type hypertension.However, there are some people who have high blood pressure that is non-scoop type, and in particular, during the treatment process, it is not only necessary to lower the blood pressure, but it is also necessary to turn the non-scoop type of high blood pressure into a scoop type of high blood pressure.

正常人血压如下图，是呈一个两峰一谷的峰谷曲线现象，跟我们用的勺子形状差不多，而这种血压也被称之为勺型血压。The "trough" refers to the nighttime trough, that is, the nighttime blood pressure is more than 10% lower than our daytime blood pressure. Spoon type hypertension has almost the same peak-to-valley pattern as normal, that is, people with this type of hypertension have a lower blood pressure at night than during the day, in the shape of a spoon.

However, non-scoop hypertension is not the same, the rate of decline in blood pressure at night is less than 10%, or even directly without the curvature of the peak and valley curves, the nighttime blood pressure may be similar to the daytime blood pressure, or even anti-scoop type, that is, as the subject said, the nighttime blood pressure is higher than the daytime blood pressure instead. And this kind of blood pressure is more dangerous, more likely to lead to dangerous arrhythmia, endothelial injury, triggering acute cardiovascular events! Therefore, it must be taken seriously!

This is entirely possible, and common causes are related to problems with taking antihypertensive medication or dysfunction in the regulation of one's own blood pressure.

First of all, the question of antihypertensive drugs, although taking antihypertensive drugs, but is taking a long-acting antihypertensive drugs? The control of high blood pressure requires a smooth lowering of blood pressure, should not be too large fluctuations in blood pressure, so the choice of antihypertensive drugs in principle is to ensure that there is at least one long-acting antihypertensive drugs. Some friends with high blood pressure still prefer to take short-acting antihypertensive drugs such as cardioplegia and captopril, but if they cannot ensure that they are taken three times a day on a regular basis, these antihypertensive drugs will not last for 24 hours, and their blood pressure will naturally rise at night.

Secondly, the problem of irregular drug taking. Some friends although eat a long-lasting antihypertensive drugs, but usually take medication irregularly, high blood pressure to eat, not high on not eat, or want to get up and then eat, resulting in unstable drug concentration, blood pressure is easy to fluctuate.

Third, their own blood pressure regulation mechanism disorders. Regardless of whether there is hypertension or not, most people's blood pressure is two peaks and one valley of the fluctuation of the way, that is, 6:00 ~ 9:00 in the morning the blood pressure rises and forms the first peak, and then begins to fall; 4:00 ~ 6:00 in the afternoon rises again to form the second peak; blood pressure falls at night, and late at night at 0 ~ 2:00 the blood pressure is the lowest, forming the trough, the night blood pressure than the peak of the daytime is lower than the peak of 10% ~ 20%. This kind of blood pressure is called spoon type blood pressure, usually only need antihypertensive drugs to take once in the morning. If the blood pressure at night is <10% or more than 20% lower than the daytime peak, then it is non-spoon type blood pressure. The subject's elevated blood pressure at night may be non-spoon type blood pressure, and it is recommended to check the 24-hour ambulatory blood pressure to further clarify the situation of the fluctuation of the blood pressure, and if it really belongs to the non-spoon type of blood pressure, it can be added a kind of antihypertensive drug in the afternoon or evening.

Whatever the case, self-monitoring of blood pressure is recommended, and if your blood pressure is truly substandard, see your cardiologist for further adjustments to your antihypertensive regimen.

High blood pressure to eat antihypertensive drugs, the purpose is to expand blood vessels, the effect of the drug over, the blood vessels and contraction, of course, blood pressure went up again, antihypertensive drugs like gas, blood vessels like a balloon, often blowing around, long time blood vessel elasticity is getting weaker and weaker, so a lot of cerebral hemorrhage, blood vessels burst is the reason for this, right! High blood pressure patients had better avoid eating, more exercise, more to regulate the body, eliminate the body's garbage toxins, so that the blood vessels are clean, smooth blood circulation, blood pressure will come down!