High Blood Pressure and Acute Gout

Question:

I am a 62-year-old retiree suffering from hypertension for nine years, treated with medication. Recently, I went through angioplasty with two stents implanted. I have morning and night medicines to take.

May I know why my blood pressure is on the high side in the morning? After medicine and breakfast, the pressure gradually goes down but it takes about two to three hours for effectiveness.

I also had a gout attack (high uric acid) which seems to be taking too long, despite food/diet control, to recover this time. It normally takes only a few days to recover after injections or medication. I wonder if it is also due to osteoarthritis.

Answer:

Our blood pressure varies throughout the day. There is a normal diurnal variation whereby the blood pressure in the morning peaks and drops at night.

There could be several factors why your morning blood pressure reading before medication is high. It could be because the dose of the medication that you are taking is not high enough or the duration of action of the drug is not long enough to prevent this early morning rise in blood pressure.

Taking a new blood pressure medication that has a longer duration of action or taking an additional dose of the same medication that you are taking now in the evening can correct this problem. It would be advisable that you consult your doctor about this.

It is unusual for an acute gout attack to take so long to resolve. You will need to consider other causes of your pain. If your joint pain is due to acute gout, then a short course of potent anti- inflammatory drug treatment would usually help the pain.

As you have repeated gout attacks, you should be on long-term treatment with medications such as allopurinol to prevent further gout attack. Repeated gout attacks can damage the joint irreversibly, eventually leading to arthritis.

Apart from avoiding food that can increase your uric acid level, it is also important that you are not taking antihypertensive medications, such as diuretic, as this can increase the uric acid level and precipitate gout.