What time of day is your blood pressure the highest

It’s not uncommon for patients to have normal blood pressure readings at home but high blood pressure readings at their doctor appointments. This can be very frustrating for hypertensive patients, especially those who are diligent about keeping their high blood pressure under control.

Patients often are nervous about what their blood pressure will be when it’s measured at their doctor’s office, and that anxiety causes their blood pressure to go up. It’s known as “white coat hypertension,” and it’s particularly common among elderly patients.

For that reason, I encourage my patients who take hypertension medication to monitor their blood pressure numbers at home.

Five tips for at-home blood pressure monitoring

Measuring your blood pressure at home is easy, and providing your doctor with a sheet of blood pressure readings gives a fuller picture than a single reading in the office once every three months.

1. Relax: Measure your blood pressure when you are relaxed, not when you’re running late or on the go.
2. Proper timing: Blood pressure is often highest early in the morning – 5 a.m. or 6 a.m. – so choose another time to take it.
3. Be consistent: Take your blood pressure at the same time of day. Discuss with your health care provider how often you should measure your blood pressure.
4. Average your readings: Hypertension specialists recommend taking three readings and then averaging the last two for the most accurate measurement.
5. Know the recommendations: Ask your doctor what is a safe target blood pressure for you.

Blood pressure machines are widely available for purchase at drug stores and online, and many machines keep track of the measurements for you. Measuring your blood pressure at home can help you work with your physician to keep your blood pressure within a “normal” range between appointments.

I recommend that my patients purchase a blood pressure monitor with an arm cuff as opposed to a wrist cuff to get the most precise readings. It’s a good idea to bring your machine along to your appointments to make sure the readings you get at home are accurate.

What’s a ‘normal’ blood pressure?

For most patients, a “normal” blood pressure reading is less than 120 for systolic (the top number in the reading, which measures when your heart is contracting) and less than 80 for diastolic (the bottom number, when your heart is relaxed).

At the doctor’s office, a systolic measurement of 120 to 139 and a diastolic of 80 to 89 are considered prehypertension for most patients. Anything above 140/90 is considered hypertension.

Away from the doctor’s office, a reading above 135/85 is considered to be high – often, people are more relaxed during readings that don’t occur at the doctor’s office.

Aside from white coat hypertension, other factors can cause your blood pressure to read higher at the doctor’s office. When a patient has to use the restroom, his/her blood pressure can increase slightly. Likewise, if a patient has to walk up a flight of stairs to reach the doctor’s office or is frustrated by a long wait to see the physician, his/her blood pressure may increase.

Consider monitoring your blood pressure at home if you’re concerned that your regular check-ups don’t provide an accurate view of your blood pressure.

If your at-home readings are higher than your target range, request an appointment with your doctor to make sure you’re measuring correctly at home, and to rule out another health condition.

If you are measuring your blood pressure at home, you may be taking it several times a day. Blood pressure has normal patterns that tend to be higher and lower at certain times of the day. Understanding these patterns can help you identify if your BP is normal or falls outside of range.

Blood pressure is usually not highest in the morning. In this article, I’ll explain more about blood pressure patterns. I’ll talk about why your blood pressure might sometimes be higher in the morning, and whether it’s dangerous.

I’ll also discuss some risk factors for morning hypertension, as well as its symptoms, diagnosis, and treatment. I’ll also outline some prevention strategies, and tell you when to talk to your doctor.

Blood Pressure Patterns

Is blood pressure usually higher in the morning?

Your blood pressure and many other body systems have a daily rhythm. Blood pressure drops to its lowest levels while you are asleep. A few hours before it is time to wake up, it starts to rise.

However, morning is not the time of day when blood pressure should be highest.Normal blood pressure rhythms peak in the middle of the day, dropping again in the late afternoon and evening.

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When is the best time to measure blood pressure? 

If you are concerned about or have been diagnosed with high blood pressure, you should measure your blood pressure at several different times of day to identify patterns. If your blood pressure tends to be higher in the morning, you should talk to your doctor, because this is abnormal.

Abnormal blood pressure patterns can indicate certain causes of hypertension or other cardiovascular risk factors.

Abnormal blood pressure patterns can be detected by taking blood pressure readings at different times of the day, including:

• First thing in the morning
• Before lunch
• Mid-afternoon
• Before dinner
• Before bed

Keep in mind that exercise, caffeine, and stress can lead to short-term increases in blood pressure. When you take a reading, try to be as calm and still as possible, with your arms and legs uncrossed. Avoid checking your blood pressure immediately after exercise or if you have just experienced a very stressful event.

Causes of High Blood Pressure in The Morning

Medical conditions

Certain medical conditions can lead to higher blood pressure in the morning. These include:

• Hypertension
• Diabetes
• Obstructive sleep apnea
• Kidney disease
• Nervous system disorders
• Thyroid disease
• Lupus

Medication

Some medications can lead to changes in your blood pressure. If your high blood pressure medication is not dosed correctly or is not effective, it can lead to higher morning readings.

If you are on blood pressure medication that does not control your morning levels, your doctor may want to reassess your dosage or switch you to a different medication.

Lifestyle

Certain lifestyle factors can lead to higher blood pressure in the morning.

These include:

• Smoking
• Stress and anxiety
• Being overweight
• Night shift work
• Lack of physical activity

Is it Dangerous?

Elevated blood pressure in the morning is not an immediate sign of danger, unless your blood pressure levels exceed 180/120 mm Hg. Levels higher than this are considered a hypertensive urgency and should be evaluated by a doctor.

High blood pressure together with a headache, weakness, chest pain, or shortness of breath can be a serious emergency that requires immediate medical care, so if that occurs, please go to the ER.

Higher BP in the morning can be a sign that you are at higher risk forblood clotting, heart attack, stroke, or cardiovascular disease. It may also lead to changes in the brain.

If you notice a consistent pattern of having higher blood pressures in the morning, your physician will want to set a plan to address it to protect your long-term health and decrease possible complications down the road.

Risk Factors

You may be at higher risk for morning hypertension if you take certain medications, have uncontrolled hypertension, or have an abnormal sleep pattern. This can happen due to untreated sleep apnea, diabetes, or as a result of night shift work.

Other risk factors include:

• Older age
• Excessive alcohol intake
• Smoking
• Longer sleep times
• Awakening later
• Cold weather climates
• Day of the week (Monday mornings are associated with higher blood pressure readings)

Your blood pressure is regulated as part of your circadian rhythm, so if your sleep patterns are off balance, it can lead to changes in your normal blood pressure. Stress and anxiety can also worsen this effect, especially if those are chronic issues for you.

Symptoms

Symptoms of high blood pressure in the morning include consistent readings that are higher than 120/80 within a few hours of waking up.

If your healthcare provider has asked you to monitor blood pressure at home, or you are doing it proactively, let your provider know if your morning readings tend to be high.

Diagnosis

Your doctor may diagnose you with high blood pressure if your readings are 130/80 or higher at any time of the day on at least two separate readings a month apart.

If your levels are higher than 120/80 but lower than 130/80, your health care provider may tell you that you have elevated blood pressure, or pre-hypertension, and you may need to monitor your levels more closely.

You may have temporary increases in blood pressure, including an occasional morning BP surge. Your doctor will be looking for a consistent pattern of fluctuations that are outside of the normal range.

Treatment

High morning blood pressure is treated similarly to general hypertension. If you are already on blood pressure medication, your doctor may adjust your dosage to help prevent a morning surge.

If you do not already take BP medication, your doctor may prescribe something to keep your levels more balanced.

Prevention

You cannot always prevent high blood pressure, but healthy lifestyle adjustments can help. Getting regular physical activity, adequate sleep, avoiding excessive intake of alcohol, and not smoking all support healthy blood pressure.

Eating a diet that is lower in sodium and staying properly hydrated may also help.

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When to See a Doctor 

You should see a doctor if your morning blood pressure readings are higher than 120/80 or you have other concerns about stress, lifestyle, or other factors that could be influencing your blood pressure.

Untreated high blood pressure may lead to harmful effects on your long-term health.

How K Health Can Help

K Health offers affordable and convenient access to highly qualified doctors to treat and manage high blood pressure, as long as you are not having a hypertensive crisis.

You can meet with your K Health doctor from the comfort of your own home via the K Health app, all while knowing that you’re getting individualized and expert care.

Frequently Asked Questions

What time of day is blood pressure highest?

Normally, blood pressure levels peak around the middle of the day and decrease again in the afternoon and evening.

Is blood pressure higher before or after breakfast?

In many cases, blood pressure drops after you eat. People who eat meals that are heavy, high in salt, or large could experience a temporary increase in blood pressure. For the best reading, take your blood pressure first thing in the morning, before consuming caffeine or food, and before doing too much physical activity.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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