How often do you check your blood pressure? If you don’t have hypertension, you may only check it on occasion, when you visit your physician for an exam or when you visit a pharmacy for another reason and use a machine to check it. But, if you have high blood pressure or borderline high blood pressure, as many people do, it’s important to monitor it more often and keep tabs on it. You should also know what your pressure is in the morning and the evening. Here’s why.
The Problem of Morning Hypertension
Some people, even those with well-controlled blood pressure, exhibit a phenomenon called morning hypertension. Despite having a normal blood pressure at night, their blood pressure spikes in the morning. Unless you take your blood pressure in the morning and in the evening, you won’t know whether you have this phenomenon.
Why is it important? Studies show that people who have morning blood pressure spikes are at higher risk of heart attacks and stroke even if they have a normal blood pressure later in the day. In fact, a study where researchers measured participants’ blood pressure every morning found that morning blood pressure readings more closely predicted death from cardiovascular causes than blood pressure readings at any other time of day.
What causes a morning blood pressure spike? When you first wake up in the morning, your adrenal glands release stress hormones, including adrenaline and noradrenaline. These hormones increase heart rate and raise blood pressure. In the morning, you also have a high cortisol level and cortisol further contributes to the morning rise in blood pressure. Morning blood pressure spikes happen shortly after awakening and can stay elevated for several hours after getting out of bed. It’s not just people with hypertension who manifest this phenomenon. Up to half of all people with normal blood pressure in the morning have a morning spike.
However, morning blood pressure spikes are more common in people who have hypertension and other medical conditions, including diabetes, obesity, and elevated lipid levels. It also becomes more prevalent with age.
Measure Your Blood Pressure at Home
It will be difficult to know whether you have morning hypertension unless you check your blood pressure at home. An at-home blood pressure monitor lets you get accurate readings without going to a doctor’s office or pharmacy. Hypertension is one of the strongest risk factors for heart disease and early death and following your blood pressure closely is a good investment in your health.
How to Check Your Morning Blood Pressure
Once you have a monitor, check your blood pressure about an hour after you wake up. Sit in a chair with your arm at heart level and make sure your arms aren’t crossed. If you have a full bladder, urinate before taking your pressure. A full bladder can cause a blood pressure reading to be inaccurate. Take your pressure three times and record the average value. Then, go about your day. Take your blood pressure again after 6:00 P.M. when you’re relaxed and haven’t just eaten a meal. Record this value too. A difference in blood pressure of at least 15 mmHg from morning to evening is considered a potential risk.
The next step is to show these readings to your physician. Health care professionals only take your blood pressure at a single point in time and they may not be aware of how much your blood pressure fluctuates between morning and evening. Once they’re aware, they can change your medications in a way that helps bring the morning reading down. Sometimes that involves taking a dose in the morning and in the evening.
It’s important to make your physician aware as having this much variation in blood pressure increases your risk of stroke and cardiovascular events. It also partially explains why heart attacks are more common in the morning. Another factor works against you in the morning. When you wake up, your blood has the greatest tendency to clot. Plus, a morning surge in blood pressure places a sudden load on the walls of arteries and this can cause a plaque to dislodge and trigger a stroke or heart attack.
Other Ways to Lower Your Blood Pressure
Natural approaches to lowering blood pressure are sometimes effective in cases of mild hypertension, but, sometimes, you need medication. Still, even if take one or more medications, lifestyle changes can further help to control your blood pressure. Here are some to implement:
· Eat more whole, unprocessed foods rich in potassium.
· Lose weight if you’re overweight. Losing as little as 5% of your body weight can lower blood pressure.
· Get enough minerals that support healthy blood pressure, especially potassium, and magnesium. Calcium is also important for blood pressure control, although calcium supplements may not offer the same benefits as dietary calcium.
· Find better ways to manage stress. Meditation, yoga, and deep breathing. These practices calm the activity of the fight-or-flight component of the nervous system. This helps to lower blood pressure.
· Eat more polyphenol-rich foods. These include dark chocolate, green tea, berries, and other fruits and vegetables. Small studies show polyphenols in certain foods help to relax the arterial wall.
· Let go of bad habits like smoking and excessive use of alcohol.
· Regular exercise – Exercise makes your heart a more efficient pump & lowers pressure.
The Bottom Line
Check your blood pressure in the morning AND the evening if you have high blood pressure. Even if your pressures are well controlled in the evening, a significant rise in the morning raises the risk of heart-related events and stroke. Carefully track your blood pressures over time. It’s one number you want to keep tabs on as it’s a risk factor for so many health problems, including heart attacks, stroke, and kidney disease. Know your numbers!
References:
JMAJ. May 2005 – Vol. 48, No. 5.
Circulation. 2011 Mar 22; 123(11): 1243–1262.
J Occup Environ Med. 2016 Dec;58(12):1207-1211.
Mol Aspects Med. 2003 Feb-Jun;24(1-3):107-36.
J Am Coll Nutr. 2001 Oct;20(5 Suppl):428S-435S; discussion 440S-442S.
Mayo Clinic. “10 ways to control high blood pressure without medication”
Heart 2016;102:1371-1379.
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