‘Nondippers’ feel hypertension

Dear Dr. Roach: My blood pressure goes up when I sleep. There seems to be no cause. I’m resistant to medication; I’ve tried 21 different kinds. All give me terrible side effects and don’t bring my blood pressure down. The only one that works is clonidine. The side effects are terrible.

Recently clonidine stopped working, and I went from 0.1 mg per day up to 0.4 mg per day in a matter of six weeks after being on it for two to three years. A month ago, I was put on a 0.4 mg weekly patch. This has been much better.

I’m 69 and a nationally ranked senior singles tennis player. I am in good shape. My blood pressure usually spikes between 1:30 to 3:30 at night. It even goes up when I take a 40-minute nap. I’ve been tested for everything: heart, renal artery, carotid artery, kidney, tumors, etc. I sure would like to know the cause of these spikes. — M.H.

The blood pressure normally goes down 10% to 15% on average when a person is asleep, a phenomenon called “dipping.” There are people who do not dip, called appropriately enough, “nondippers.” Some people experience a blood pressure increase at night, called nocturnal hypertension.

It is not always clear what is causing this condition. Kidney disease and previous heart problems are associated.

Treatment for nondippers often includes giving blood pressure medication at nighttime. Melatonin has also been tried to alleviate nondipping.

Clonidine works at the level of the brainstem. One potential cause for which you have not mentioned being checked is obstructive sleep apnea. The most effective drug is often clonidine. If you have not had an evaluation for OSA, your physicians should consider it. Sleepiness during the day is a cardinal symptom of obstructive sleep apnea.