Q I am 62 and a retiree and have been on medication for hypertension for nine years.

Recently, I had an angioplasty with two stents implanted. My kidney is also under medical renal post-procedure monitoring and I take medication in the morning and at night.

I would like to know why my blood pressure is high in the morning - usually 150-165 over 85-90.

After medicine and breakfast, the pressure gradually goes down but it takes about two to three hours to do so. It is all right in the evening - in the range of 120-135 over 80-85.

I also had a gout attack which I have not recovered from in two months although I control my diet. It is mostly around the ankles. Is this due to osteoarthritis? When I was in my 30s, the gout attacks were usually around my knees.

A Our blood pressure varies throughout the day. There is a normal diurnal variation whereby the blood pressure peaks in the morning and falls at night.

Your morning BP reading before you take any medication is high. There could be several factors. It could be because the dose of the medication that you are taking is not high enough or the duration of its effect is not long enough to prevent this early morning spike. You should consult your doctor about this.

It is unusual for an acute gout attack to take so long to resolve. You will need to consider other causes for your ankle pain. If your joint pain is due to acute gout, then a short course of potent anti-inflammatory drugs will usually help the pain.

Since you have repeated gout attacks, you should be on long-term treatment with medication such as allopurinol to prevent further attacks. Repeated gout attacks can damage the joint irreversibly.

Apart from avoiding food that can increase your uric acid level, it is also important that you avoid anti-hypertensive medications, such as diuretics, as this can increase the uric acid level and precipitate gout.

Dr Ng Wai Lin

Dr Ng Wai Lin is a specialist in cardiology at Raffles Hospital

This article was first published in Mind Your Body, The Straits Times.