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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Fluctuating Blood Pressure Levels?

My blood pressure drops each day afternoons and rises every night and stays high a few hours. The systolic spreads 70 to 100 points. This happens every day, and I am taking metoprolol and losartan twice a day, and amlodipine once a day. My doctor cannot increase meds because of daytime lows (e.g., 96/48 or 101/57) and nighttime highs (189/95 and 195/94). I have been tested with 24-hr. Urine collection for adrenal function and also blood test for renal arterial stenosis, but both came out negative. Any ideas what else should be checked? Am losing weight/sleep/emotional well being. Please help.
Thu, 31 May 2018
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Diabetologist,  's  Response
Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

I think it is quite possible that the effects of the medicines is wearing off by the evening and therefore the blood pressure starts to rise. I would not recommend that you change the medicines yourself. I would recommend discussing these with your treating doctor.
1. change Losartan to a drug that acts longer like Olmesartan.
2. take the Amlodipine medicine at a later time than you take currently.
3. if needed, a small dose of Amlodipine may be added in the evening.

Since I do not have the exact doses of the medicines you take, I cannot give a more specific recommendation.

Please let me know the doses of medicines for more specific information.

I hope these suggestions will help you.

Best wishes!
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What Causes Fluctuating Blood Pressure Levels?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. I think it is quite possible that the effects of the medicines is wearing off by the evening and therefore the blood pressure starts to rise. I would not recommend that you change the medicines yourself. I would recommend discussing these with your treating doctor. 1. change Losartan to a drug that acts longer like Olmesartan. 2. take the Amlodipine medicine at a later time than you take currently. 3. if needed, a small dose of Amlodipine may be added in the evening. Since I do not have the exact doses of the medicines you take, I cannot give a more specific recommendation. Please let me know the doses of medicines for more specific information. I hope these suggestions will help you. Best wishes!