Suggest Treatment For Increase In BP Levels At Night

Posted on Mon, 2 Mar 2015

Question: Good Afternoon
I have COPD and also hypertension. The last couple of days I have had an unexpected flareup of my blood pressure. I take clonopin .1mg 3 times a day nd am on a symbicort inhaler 160/4.5 2times a 24hr period. This morning I found my BP very high just before I took my first clonopin. It took care of the elevation until about 10:30am when It started to go back up. . I took one half clonopin and it took care of it until 1pmwhen I had to take another 1/2 . Again it was one hour later and it was fine. However I just took my BP again and it's unacceptable iI took 1/2 pill as I won't be able to take any more at bedtime to take me thru the night. My question isI can I take more than the 1/2 I just took and still take another whole one at bedtime. It's obvious that my Doc. is going to have to switch me over to something else or increase my dosage/times. to-morrow but can you get me through the night with dosage. I'm getting really upset which is making matters orse. Also is the inhaler making things worse? Thank you XXXXXXX XXXXXXX

Answered by Dr. Shoaib Khan (1 hour later)

Brief Answer:
Need current and average BP readings to decide ma'am

Detailed Answer:
Hello XXXXXXX and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I would like you to first understand a few things before we consider taking another half of the clonopin.

You are going to sleep soon as it is bedtime, and when you are asleep your blood pressure and heart rate will be mostly stable due to absence of influencing factors (I hope you know what I mean). So taking extra anti-hypertensive medications so close to bedtime (especially if the blood pressure is not too high) can cause a drop in blood pressure (and I am sure you know how hypotension is dangerous).

Next you need to understand that at this point of time, your blood pressure reading (before taking the next half tablet clonopin) is important as this will help us decide whether or not you need the extra half. Please write back to me with your current blood pressure, and also your average blood pressure (just for comparison).

Coming to the symbicort inhaler, you are quite right in suspecting this to make things worse. Symbicort has many side effects and raising blood pressure and heart rate are both part of the list. So I would recommend against the usage of the inhaler till you can meet your doctor tomorrow. Please also write back to me with the required blood pressure at the earliest so I can help you immediately ma'am.

Looking forward to hearing from you in order to help you further. Please also feel free to write to me about any other clarifications you have, I am always here to help.

Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (35 minutes later)

The reason that I try to take Rx at bedtime is that I have Mild sleep apnea .As you know that affects my problem to a small degree. That is why when I get up my BP is high. When I first started taking the clonopin, the whole tablet was far too much for me and 1/2 tablet was fine.Then I guess my body was getting used to it and it wasn't working as well. I started taking the whole tablet when I got up and 1/2 the other 2 times.Then out of the blue my diastolic started climbing & after taking my Rx (this was in the morning) it settled back down to an acceptable normal figure. I take my BP regularly trough the day and I'm sure worry has alot to do with it along with stress. I will talk to my Dr early to-morrow and I have an appointment on Tuesday to see a specialist. So I would appreciate your opinion to get me through the night as to dosages and how often I can use the medication at hand. I had to take a whole tablet at @5:55pm to-night as my Bp. climbed to 197/99 pulse 81. So to-day I took a whole tablet at 8am , 10:30 am 1/2 tablet,1/2 tablet @1:10pm. Now what to-night? I don't want to stroke out!

Answered by Dr. Shoaib Khan (7 minutes later)

Brief Answer:
Best to take an entire tablet tonight

Detailed Answer:
Hello once again ma'am.

Your readings are indeed high, and I would also like to thank you for taking out time to explain things out to me with so much patiencd, I really appreciate it.

With the given situation and BP readings through the day, it may be in your best interest to take an entire tablet at bedtime. I am sure it will not cause your BP to drop to dangerously low levels, in fact it will keep your BP at bay and prevent from any harmful effects high BP can cause.

So the best thing would be to take an entire table, as you are actually advised to take 3 tablets in all, and you have only take 2, taking another one (whole) will sum it up to 3 tablets in all, which is what your doctor had prescribed in the first place. Also try to relax, and avoid stressing it. Get some sleep, and your doctor will take care of the rest tomorrow ma'am.

I hope and pray for the best for you, and am sure the clonopin will tale care of you tonight. Sleep tight and best wishes ma'am.

God bless.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar