Did you know that most people have a natural dip in their
blood pressure (BP) while they are sleeping? 
Yeah, it can drop up to 20-30 mm Hg (mm Hg means ‘millimeters of mercury’-
nothing really important for you to know). 
The real benefit is that when your blood pressure drops, your blood
vessels and your heart don’t have to work as hard.  That means that they get to take a
well-deserved break!  Of course, this is appreciated
by your entire body.  But there is some new evidence to show that
some of us don’t get that protective bedtime drop.  Actually one study done by the American
Journal of Kidney Diseases found that 60 percent of African Americans don’t get
the dip and 40% of those non-dippers actually spike to higher blood pressures
at night!  This is a major reason for
some to switch the dosing of their BP medications to bedtime dosing.  This way they get the protective coverage
when their risk of having a heart attack or stroke might be the highest.

Now, I don’t want you to get vigilante and start changing
things on your own.  Talk to your
doctor.  Sometimes, it might be necessary
to spread out your meds to cover the entire day or you might be taking a
particular medication that is better taken during the daytime hours.  An example would be a diuretic- otherwise known
to most patients as ‘The Water Pill.’ 
These medications lower your blood pressure by making you urinate out
water.  This works by reducing ‘the
pressure’ of your blood (water) in your blood vessels (pipes).  Diuretics are popular amongst women who like
the reduction of swelling in their hands, feet and ankles.  However, if you dose this medicine at
bedtime, you might be up multiple times throughout the night tinkling… this is
not good for your body in the long run. 
Remember, good sleep is an integrative medicine biggie goal!  This is when your body is trying to reset and
restore itself for the next day’s challenges. 
Continuous and deep sleep is essential so it might be wiser to take your
diuretics in the morning.

Whatever the regimen, remember the goal of blood pressure
medications is to lower your blood pressure to a goal of 120/80 mm Hg or
less.  If you have been reading some of
my previous posts (and please do for other practical ways to approach your
medical care), you know I can’t leave you without reminding you that good lifestyle
practices (nutrition, exercise and mental health) can match even the best BP
medications’ abilities to lower your BP… and they won’t make you sing ‘gotta
go, gotta go’ in the middle of the night! 

Oh, and by the way, as we head into Thanksgiving festivities and its potential associated gluttony, remember to watch your salt intake… a visit to the emergency room is not what you or your family wants to be thankful for that day!  Less than 2000 mg of sodium per day is the recommend limit! 

On that note:  My thanks to my family, my patients, my community and you for allowing me the opportunity to’ Pay It Forward.’  I am eternally blessed to gain wisdom through the lives and stories of all those who share their stories with me.  They teach me more than just medicine; they teach me the art of living well and I hope you, too, can benefit from these experiences.