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Q: I am a 56-year-old woman and have had high blood pressure for the last 4 1/2years.
I am taking 5mg amlodepine and I try to brisk walk at least two or three times a week.
My weight is 60kg and my height is 1.57m.
For the past year or so, I have noticed that my blood pressure readings in the mornings are particularly high - ranging between 145 millimetres of mercury (mmHg) over 90mmHg and 152/92mmHg - despite the fact that I have had a good night of uninterrupted sleep.
There is usually a slight heaviness on the top of my head when I get up.
However, after a brief walk in the garden, the blood pressure reading drops below the 140/90mmHg mark.
The day readings are in the range of 132/85mmHg to 138/88mmHg.
What can I do to stop the high blood pressure readings in the mornings?
A: It is commendable that you are making an effort to exercise three times a week.
Indeed, regular exercise has been shown to be beneficial for the heart and control of blood pressure.
In addition, decreasing your daily salt intake and embarking on the Dietary Approaches to Stop Hypertension (Dash) diet - which emphasises fruit, vegetables and low-fat dairy food - have also been shown to be useful in lowering blood pressure.
A normal blood pressure reading should be less than 130/80mmHg.
Your symptom of morning headache or heaviness of the head is of concern as there are a number of possible diagnoses.
These include brain tumour, migraine, a tension type of headache, obstructive sleep apnoea and caffeine withdrawal.
You should review the symptoms with a physician as further evaluation may be necessary.
In the event that the symptom is solely due to the surge in blood pressure in the morning, this can be managed by adjusting the timing of the medication, adjusting the dosage of the medication or changing the type of medication.
The overall aim of blood pressure therapy is to keep the blood pressure under control throughout the day.
In certain patients, a 24-hour ambulatory blood pressure monitor may be ordered to profile the blood pressure trend over a 24-hour period.
The monitor consists of a small, wearable digital blood pressure machine that is connected to a cuff around the upper arm.
The machine will automatically measure the blood pressure at regular intervals throughout the day and night.
These readings are stored in the machine and analysed at the end of the 24-hour period.
Medication can then be changed or adjusted according to the recorded trend.
DR TAN CHIEH SUAI
Consultant at the department of renal medicine at Singapore General Hospital
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