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What Causes High Systolic Blood Pressure In The Morning?

Posted on Sat, 14 Jun 2014

Question: My Mom is 89 and has stage IV kidney disease. Here blood pressure has been running high. In the mornings it is in the low 180 systolic while the diasystolic is usually under 80 and sometimes around 60. She is taking three medications. Atenelol, diovan,norvasc. She just started taking 40 mg of Prozac and some .5 Zanax for anxiety. She has been taking prozac for years but only 20 mg. Can you advise and tell what the cause of the systolic is so high in the mornings. She had her gallbladder removed last year. She has acid reflux and a hiatial hernia. She does not do well on solid foods, so she drinks insure and eats yougart and icecream. Thanks!She had blood work two weeks ago and it was all good or ok. She had an MRI of the abdomen and it shows no problems, but she has acid reflux and cannot eat much. She takes Aciphex twice daily for her stomach.

Answered by Dr. Hardik Thakker (4 hours later)

Brief Answer:
add alpha blocker/ diuretic

Detailed Answer:
Dear XXXXXXX .
Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.

I can very well understand your anxiety with regards to your mothers health.

since she is having stage 4 ckd, her kidneys are not able to excrete enough water. this causes high blood systolic blood pressure which is often resistant to many drugs. Geriatric patients have thickened arterial wall due to atherosclerosis. this also causes high systolic BP. she is currently on 3 drugs for high BP.

We now have 2 options:

Add a fourth drug which is an alpha blocker and or a diuretic drug. The rules of the website do not allow me to prescribe a particular drug.

We can have more ultrafiltrate removed on hemodialysis if she is on maintenance hemodialysis.

Her other disease conditions do not directly contribute to high systolic BP.

I would like to know if she is hyper or hypothyroid...because you mentioned she is hyperthyroid and on synthroid. both cannot happen at the same time.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Hardik Thakker (2 days later)

My Mother was on a diuretic, however she became dehydrated and had to spend the night in the hospital. They told her to stop taking it.

As of today, her BP is a little better, but the top number is still high.
Can you tell me what would make the top number go so high and the bottom number is normal?

She also has bad acid reflux and cannot eat solid food, now lives on Insure and yougart and ice cream. She is not loosing any weight. She is 5'5" and weighs 147,
Thanks!

Answered by Dr. Hardik Thakker (20 minutes later)

Brief Answer:
Please read the response

Detailed Answer:
Dear XXXXXXX

Isolated systolic hypertension is the term used for this wherein the systolic pressure is high and diastolic is normal. This is due to atherosclerosis of the arterial wall in old age.

I would recommend a careful titration of diuretic or an alpha blocker, just enough to get the systolic pressure down. if the dose given is very high she may go into hypotension. Rules of the website prevent me from prescribing a particular drug.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj