Why would my blood pressure only spike in the evening from 7 to 12 pm.

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I Discovered I had a BP of 206/110 on Nov 27/2017. I have had borderline hypertension for the last 15 years which didn't require any medication and my doctor couldn't advise any lifestyle changes that I wasn't already doing.

I'm 63, healthy, 6.1" and 184lbs, at the gym 4 times a week, low sodium ovo/lacto vegetarian & daily Zen meditation practitioner for the last 44 years, drink plenty of water, non smoker, non drinker, good sleep regiment, now retired with a low stress lifestyle. My mom did had BP problems with many mini strokes so they think this is an inherited condition. Numerous blood and urine tests for me come back as all good.

My Doctor has now proscribed 4mg daily Coversyl (perindopril) since my high BP reading.. I have been measuring my own BP about 5 times a day since then. This medicine lowers my BP through most of my day to a good range but the systolic still rises by 30mg back to the hyper tension range from 7 - 12 pm every evening. Taking my medication at different times doesn't change this. Taking a nap  during the day makes no difference to it.

Does anyone have evening BP spikes or any possible explanations for why it consistently rises in the evening?


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  • Posted

    Many people develop HBP in their 50's and 60's. I developed it overnight at 64 in October and eat right, avoid salt, etc. Usually was 130's over 90's where before I was always low.  Same new diagnosis with my slim friend who is 67.since then I am on 10 mg lisinopril and 3 mg twice a day of CoReg.

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    • Posted

      Thanks Veewat for your input.

      I guess I was hoping that having a consistently spiking BP reading in the evening might of indicated a possible cause for the high BP.  Mine seems to rise in the opposite time of the day to what most people  with high BP readings report.

      I have questions about what happens to the human body blood circulation system that is different in the evening than from the morning, that might explain the high evening BP readings.

      For example... I think there is a hormone that the body normally produces that increases the BP during the day but then usually reduces that production for most people in the evening..except for many folks with Cushing disease. Their hormone production continues  unabated through the evening, often resulting resulting in high BP.

      I am just a layman hoping to zero onto a possible diagnostic cause for my high BP that might be able to be addressed, rather than meekly accepting a lifetime of medicine for a symptom of something else that might be able to be treated..


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  • Posted

    Hi Howard

    It may be because we tend to eat more in the evening, not really sure though. Your BP is very high, yet you seem to have a healthy enough lifestyle. Are you aware that a vit D deficiency can cause high blood pressure? maybe you could ask your doc to test you for a deficiency. 

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    • Posted

      Thanks Gillian

      I guess it would be easy and quick test to try reducing my supper intake for a while and see if it affects my evening BP. I'll try that tonight.

      I know that the body does regulates greater blood flow to the abdominal areas to aid in of digestive absorption  from the extremities immediately following a meal. Not sure how that might increase or decrease cuff BP readings from my left arm.

      My Vit D came back OK, probably due to the time I spend in the Sun, kayaking, biking and skiing, oblivious to potential skin cancer.


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  • Posted

    Dear Howard,

    ?My initial guess is that You need to ask your Primary GP about your dividing your dosage into Morning and evening.

    ?The Half Life of Perindopril seems to be less predictable than a lot of the other BP Meds.  Plus all of us are different metabolically.  You said you drink a lot of water and this is a good thing.  However, in your case, you possibly are eliminating the Perindopril more quickly than someone who doesn't drink as much water.

    ?If you research Perindopril, you will find its' effective Half Life can be as short as 3 Hours with detection in lesser amounts for 30 Hours.

    ?I am on Lisinopril and must take mine morning and evening because I drink so much water.

    ?Lastly, you are on the Lowest dosage for this Med.  Usually after Two Weeks of acceptable Toleration of this drug, You will have your dosage increased from 4 to 8 Mg.  Soooo, maybe in the meantime, your GP  will agree to your halving the dosage and take A.M and P.M.

    ?I think - but discuss with your GP or Pharmacist about Breaking in half.

    ?For what it's worth, Pharmacists know more about Meds overall than the GP's!  

    Good Luck!   Ernie

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    • Posted

      Thanks ErnieSC..really good info.

      My Dr. initially said I could take my dosage either in the morning or in the evening. She said she'd recommend taking the 4mg dosage in the morning and take a baby aspirin at night. If my BP couldn't be brought down under 140/90 within a week with that dosage, then double the Perindopril dose or try a 4mg Perindopril/water pill combination.  I think the morning is the usual time to take it as that is when most people have the highest BP...plus with sleep difficulties being one of the most common side effects, the Perindopril is probably much diluted out of the body by the evening.

      I had already moved the time to take my pill from 8am to 1pm to see if the Perindopril was actually wearing out by the time my BP normally starts to spike but now I'll try moving it closer to 3pm to see if that can help moderate that evening BP spike. My Morning and mid day BP  seems pretty much OK without any Perindopril.  As an example, this morning it was 108/68 but typically will start rising in the afternoon up to 138/82 in the evening.

      I agree about the pharmacists generally being more knowledgeable about the Meds than your average GP.


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  • Posted

    i do my daily check in between the hours of 6-8pm

    well after i have had food or drink at least one hour

    i rest for 10 mins then take three readings...3 mins apart...with quietness and a calm mind at all times.

    i recite the lords prayer and another prayer called jabez prayer .. 1 Chronicles 4:10 .. if you are interested

    i usually get 3 quite close readings and take the average

    i am taking meds so i believe that they are working and going to give me good readings

    all positive thinking and borne out by the results

    i don't want high blood pressure!!

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    • Posted

      Hey mrcrow

      I use zen meditation to relax any mental, emotional or physical tension before my BP testing. It feels like a bit of a cheat because it probably doesn't reflect my daily BP but my Doc says what ever makes me relax for the BP test is OK.  I'm sure your prayer fulfills some of the same functions.

      It's great that your blood pressure is so stable. Mine can easily vacillate 5 mg in 5 minutes whether I take BP medicine or not.

      As a side note.....

      My BP machine literature tells me not to take any BP readings within 5 - 10 minutes of the last reading to enable the blood flow in the arm to return to normal after being cuffed but it agrees with you on the importance of taking ones blood pressure at the same time every day. The machine is 15 years old so maybe their info is outdated.


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    • Posted

      5-10 minutes is better than just 5

      i think i got this information from the BPmonitor manufacturer omronM6 model

      the three minutes between they say is to allow the artery to return to its normal size after diastole...i think that most good arteries should be flexible enough to do that

      my readings using this...so far...have been consistent with the starter reading e.g.

      1st reading 127/84

      2nd reading 120/80

      3rd reading 118/78

      average of the three approx 122/82

      these readings arent diagnostic and the result of the meds...but that is what its all about...peace of mind and following the MD's advice.

      i would need his permission to stop any medication, but in the light of my own readings, using the same apparatus they do but giving positive periods of rest before and between, conducive to suspect my readings at the clinic, the basis for the prognosis, may be a bit higher than my day to day 'at rest' BP.


      if you are into zen have you read haiko?


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  • Posted

    Hello I too seem to have higher readings at night than in the morning, mine is usually 145/90 at night and when get up it's 125/80, sometimes I wake out of my sleep heart beating fast, it scares me so I get up that's when I checked my bp last night cause my hands were numb

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    • Posted

      Yes I have a machine but never could get used to it, my wife said I did get better with snoring, but maybe I need to check for more options, I sleep on my stomach and I can not sleep on my back my machine I have I cannot sleep on stomach 
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    • Posted

      Hey Bigmarlon34

      I guess you know then that Sleep apnea  often causes high BP and is also one of those malady's considered to be a secondary cause of hyper tension .....meaning that just by taking care of the sleep apnea, might mean being able to reduce or eliminate your need for BP medication.

      Boy the masks that those machines require look cumbersome to use though.

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