Nighttime blood pressure spikes are a significant concern because they increase cardiovascular risk. Normally, blood pressure dips during sleep, but did you know certain factors can cause it to surge, leading to potential complications? Also read | Cardiologist explains 10 signs of heart disease you ignore but should not: Irregular heartbeat, swollen feet, jaw pain
Consequences of untreated nighttime BP spikes
In an interview with HT Lifestyle, Dr Narasimha Pai, consultant and head, cardiology, KMC Hospital, Mangalore, said, “Nighttime blood pressure spikes are a red flag because they increase cardiovascular risk.” Dr Dibyaranjan Behera, consultant interventional cardiologist, Manipal Hospital, Bhubaneshwar added, “Nighttime blood pressure spikes may be easily missed, but they are very dangerous for patients with hypertension, heart failure, or those recovering from a stent procedure.”
He shared that taking blood pressure medication at the right time may provide better control over nighttime spikes and said, “Missing prescribed nighttime doses can leave room for blood pressure to spike while the patient should be resting, which increases the risk of stroke, heart attack, and other complications. Providers repeatedly express the need for waiting until we can accurately measure blood pressure before treatment consideration.”
Dr Jyoti Kusnur, consultant interventional cardiologist at Manipal Hospital, Goa, shared, “Healthy blood pressure follows a circadian rhythm: in healthy individuals, it falls ~10–20 percent during sleep — the nocturnal dip. This off-duty period lowers heart muscle’s oxygen demand, wall stress, and sympathetic tone, allowing the body’s natural repair process to heal from wear and tear and stresses accrue during the waking hours.”
“When pressure fails to dip — or rises (non-dipping/riser) — the nighttime load accelerates injury to the internal linings of blood vessels, causes left-ventricular hypertrophy and kidney microdamage, and insulin resistance. Clinically, nocturnal hypertension and exaggerated morning surge track with higher risks of heart attack, stroke, and sudden cardiac death, particularly between 4–10 am, when the stress hormones, namely, cortisol, catecholamines and also platelet (blood cells) stickiness, and vascular tone peak,” Dr Kusnur said.
Explaining why it is missed, Dr Kusnur said: “Clinic checks capture daytime snapshots, while many patients have masked or REM/obstructive-sleep-apnoea-related spikes only at night. 24-hour ambulatory monitoring (and validated home night-BP devices) reveals the pattern and guides therapy.”
Causes of nighttime blood pressure spikes
As per doctors, stress, shift work, and late-night screen use can disturb the circadian rhythm, making blood pressure surges stronger and more dangerous. Consuming high-sodium or heavy dinners, alcohol, caffeine, and nicotine can also interfere with normal blood pressure control at night.
Dr Pai explained, “Normally, BP dips during sleep, but hormonal surges-especially cortisol and adrenaline released in the early morning-can push it higher, sometimes excessively. Stress, disrupted sleep, shift work, and late-night screen use disturb the circadian rhythm, making these surges stronger and more dangerous. Lifestyle choices also play a big role: high-sodium or heavy dinners, alcohol, caffeine, and nicotine can all interfere with normal BP control at night.”
High-risk groups
According to him, those at highest risk include: women with PCOS, where hormonal imbalance worsens BP variability, patients with obstructive sleep apnea, who experience repeated oxygen drops that trigger spikes, and individuals on irregular medication schedules, which leave gaps in BP control. “Identifying and managing these factors is critical, since nocturnal hypertension is closely tied to higher rates of heart attack, stroke, and sudden cardiac events,” Dr Pai said.
Managing nighttime blood pressure spikes
According to Dr Behera, today, we have more opportunities than ever, with home blood pressure monitors, smart wearables, and 24-hour ambulatory monitoring that provide real-time evidence of nocturnal patterns: “The most important thing is being able to measure, understand the numbers, and act when necessary. Measuring at the right time, tracking the measurements, and understanding the implications regarding heart health can ultimately save patients from something dangerous and silent while they are sleeping.”
Who should screen? According to Dr Kusnur: “Snorers who may have obstructive sleep apnea (when the oxygen levels dip during sleep), diabetes, chronic kidney disease, resistant hypertension, older adults, and shift-workers. 24 hour ABPM (Ambulatory BP monitoring) is now a widely available, inexpensive and simple testing tool to diagnose Non-dippers.”
What helps? Dr Kusnur said to treat obstructive sleep apnea, reduce evening salt/alcohol, get regular sleep, and individualise the timing/intensity of antihypertensives (chronotherapy, that is, tailoring BP medications and adjusting timings according to the 24-hour BP behaviour in any patient) under a cardiologist’s supervision.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.