- With Mayo Clinic emeritus hypertension specialist
Sheldon G. Sheps, M.D.
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Sheldon G. Sheps, M.D.
Sheldon G. Sheps, M.D.
Dr. Sheldon Sheps, emeritus professor of medicine and former chair of the Hypertension Division in the Department of Medicine at Mayo Clinic, has been with Mayo Clinic since 1960.
Dr. Sheps, a Winnipeg, Manitoba, native, is board certified in internal medicine and specializes in hypertension and peripheral vascular diseases. He developed a multidisciplinary approach with specially trained nurses, dietitians, technicians and educators to help form a team approach to the treatment of patients with abnormal blood pressure.
"I have always believed in involving the patient and family in their health care," he says. "I have asked for their understanding of the illness and issues and for participation in decisions. The Web is a natural extension of that, and now many more people can be informed."
Dr. Sheps chaired the sixth working group, and participated in the fourth, fifth and seventh groups, that developed the then-latest guidelines for hypertension under the auspices of the National Heart, Lung and Blood Institute (NHLBI). He helped write the latest American Heart Association (AHA) report on blood pressure measurement. He chaired an AHA group that produced an online accreditation for blood pressure measurement for health professionals. He has co-authored books, newsletters, CD-ROMs and other Mayo Clinic health information material and joined Mayo Clinic's Web team in 1998. He was medical editor-in-chief of both editions of the "Mayo Clinic on High Blood Pressure" book; the last edition was published in 2003. He was also medical editor-in-chief of "Mayo Clinic 5 Steps to Controlling High Blood Pressure,'' published in 2008.
He was section editor for each of the first three editions of "Hypertension Primer" for the American Heart Association.
Dr. Sheps was also chairman of the Science Base Subcommittee, National High Blood Pressure Education Program, and was a consultant to the Hypertension Initiative of the World Health Organization. In 1997, he was honored with the Individual Achievement Award on the 25th anniversary of the National High Blood Pressure Education Program of NHLBI. In 2009, he was honored as a Distinguished Mayo Alumnus.
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Question
Blood pressure: Does it have a daily pattern?
Does blood pressure have a daily pattern? I've noticed that my blood pressure is always lower in the morning than at night.
Answer
from Sheldon G. Sheps, M.D.
Like many body functions, blood pressure has a daily (diurnal) pattern. Blood pressure is normally lower at night while you're sleeping and when you first wake up. As soon as you get out of bed, your blood pressure starts to rise. Your blood pressure continues to rise during the day, usually peaking in the middle of the afternoon. Then in the late afternoon and evening, your blood pressure begins dropping again.
Factors that may cause an abnormal daily pattern, such as high blood pressure in the morning, include:
- Poorly controlled high blood pressure
- Sleep apnea
- Tumors of the adrenal gland
- Kidney disease
- Certain medications, such as corticosteroids
- Night-shift work
- Caffeine use
- Tobacco use
- Too much stress
Blood pressure lowering medications also can alter this pattern because some may not last a full 24 hours. Other medications taken at bedtime are formulated to start working a few hours before you wake up to control the morning surge in blood pressure.
Your doctor can evaluate the significance of an abnormal daily blood pressure pattern. He or she may recommend a 24-hour blood pressure monitoring test. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over a typical day and night.
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