Blood Pressure variations

[Cees]

My wife is 81 yir., has been treated for high blood pressure for over 3 years and has had about 5 atrial fib events.  She went to the ER in Sept 2001with an afib, and after more than 24 hrs. of tests in the hospital our internist diagnosed it as PAT He has tried to control her BP with various meds. (Diovan, Diovan HCT, Zebeta) and after the last serious atrial fib Oct. 2003 (at home), the ER Dr. used a lanoxin shot to reduce the high and irregular pulse.  She now takes Toprol XL 25mg,  HCT 25 mg, and 0.5 tab Lanoxin 0.125mg after brk, Norvasc 2.5mg after lunch, 0.5 tab Toprol 2 to 3 pm, and Lanoxin 1 tab about 7 pm.  
1.  Her BP always rises in late afternoon and after supper.  Is this normal for BP to rise late in the day taking these medicines?  She doesn’t have a rise in her BP in the morning.  
2.  Ideally, she would like to take meds  at regular times without having to check her BP with the monitor.  E.g., based on the info above, could she take clonidine at 5 pm, another at 9, and another at 10:30?  Would it be harmful to take a pill at regular times w/o using the monitor even though the BP actually may be less than 140?
3. Her BP rises every night when in bed.  In an expt. I measured my BP sitting and on bed and then sitting again. No change. However, her BP in morning does change from 115-67 to 152-80 and then 124-71 in chair. All readings after 10 min & 3 readings. Should she take the on bed readings before clonidine or in chair?
Thank you so very much for any help.

[Cleveland Clinic]

Cees, thanks for the post.

1) It is difficult to say. One option would be to try to change the time of the day that her medications are administered.  If she is taking clonidine, it may be an effect of the medicine wearing off. Instead of a pill, perhaps a patch would be something to look into.

2) Yes.

3) Dont focus too much on the individual readings. You are taking her pressure too many times. I would take them 2-3 times a day. Do it at the same time and in the same position. You are killing yourself in the details with this.

Also she is submaximal doses of multiple medications, norvasc, toprol, and clonidine. I would pare them down to one, maximize it, then add another and maximize it. It might help keep you more steady through the day.

good luck

[Cees]

I forgot to add that my wife take Clonidine 0.1mg every time BP rises above 140.  She has to do this generally from 3 to 6 pm, 4 to 8 pm, and sometimes another 10 to 11;30.  An echocardiogram showed no abnormalities.  Since we are new to this forum, what are the sensations associated with PAC and PVC experiences?  She has had irregular heart beats for years.  Thanks so very much.
Cees