We all know that blood pressure is the lateral pressure of blood flowing in blood vessels against the walls of blood vessels, and that normal blood pressure should be <140/90 mm Hg. So, is the blood pressure of a normal person set in stone? The answer is no. The formation of blood pressure is determined by three main factors, namely the ability of the heart to contract to shoot blood into the peripheral vasculature, the rapidity of the heart rate, and the amount of peripheral vascular resistance. These factors, in turn, are influenced by many factors. Blood pressure is usually lower in a quiet, resting state; it is higher during labor, emotional changes (e.g., happiness, sadness, stress), eating, and defecation. A transient increase in blood pressure due to strenuous exercise, mental stress, or sudden excitement is a normal response of the body. The fluctuation of blood pressure is divided into two types: long-time fluctuation and short-time fluctuation. The blood pressure of a person changes from time to time throughout the day, and we call the transient fluctuation of blood pressure that changes with the change of heartbeat the short-time fluctuation of blood pressure. In a person's general state of activity, this fluctuation is expressed as blood pressure fluctuating around a base value. The diurnal variation of blood pressure throughout the day is also called the short term fluctuation of blood pressure. Most people's blood pressure values have a "double peak and a valley" characteristic, with 6-8 a.m. and 5-8 p.m. being the peak hours of the day and 1-2 a.m. being the low hours. At night, blood pressure at rest is usually 10% lower than during the day. A small number of patients also have only one peak in the morning or evening. There is also a special phenomenon of blood pressure fluctuation - the morning peak of blood pressure, which is manifested as a significant increase in blood pressure in the morning just after opening the eyes, 30% higher than the lowest blood pressure at night. Long-term fluctuations in blood pressure include differences in our blood pressure measurements over several days and seasonal fluctuations in blood pressure. How do we know how volatile our blood pressure is? By measuring blood pressure, of course. There are three ways to measure blood pressure: patients measure their own blood pressure at home, doctors measure blood pressure in the office, and ambulatory blood pressure monitoring is performed. Currently, the diagnosis of hypertension still depends on the blood pressure measured by the doctor in the office, and the assessment of hypertension risk and treatment goals are based on the office blood pressure. However, in-office blood pressure only reflects our blood pressure at one point in time during the day and does not truly reflect the fluctuating state of blood pressure. Therefore, doctors recommend that patients take their own blood pressure at home. Because blood pressure is measured in the familiar home environment, home blood pressure measurement can reflect our blood pressure level in our daily life and avoid the "white coat effect" of seeing a doctor with elevated blood pressure. It can also be used to assess the long-term fluctuation of blood pressure and the effect of antihypertensive treatment over a few days, weeks, or even months or years, and to remind patients to pay attention to their blood pressure and increase compliance with medications for hypertensive patients. For cases such as high and low fluctuations in your own blood pressure measurements, or when you have just been diagnosed with hypertension and have changed your antihypertensive medication, your doctor will perform ambulatory blood pressure monitoring, which is a monitoring device that automatically measures blood pressure. After wearing it, the blood pressure is automatically measured and recorded every half hour during the day and every hour at night, so that it can clearly reflect the fluctuation of our blood pressure throughout the day and help the doctor to treat it more reasonably. There are several special cases of blood pressure fluctuations that need special attention, and we will talk about them separately below. 1.Non-Arytenoid hypertension: As mentioned earlier, our blood pressure is in the form of a double peak and a valley, like the shape of a spoon. If the blood pressure at night is similar to that during the day, we call it "non-ascending" blood pressure. Normal people can also have a non-ascending blood pressure pattern, but because the blood pressure is within the normal range throughout the day, it does not cause harm to our heart and brain and other organs. In hypertensive patients, if the blood pressure is not lowered at night, the time spent in hypertension throughout the day is significantly longer, and the organs of the heart, brain and kidneys are vulnerable to damage when they are under increased pressure for a long time. In the heart, the most common are enlarged atria and thickened heart muscle. If non-arrythmia hypertension is detected by ambulatory blood pressure monitoring, we must first consider whether there is poor nighttime sleep and sleep apnea. After excluding other factors that lead to high blood pressure at night, we can correct the blood pressure pattern by taking long-acting antihypertensive drugs and changing the time of medication to lower the blood pressure at night. 2, the morning peak phenomenon of blood pressure: the morning is a time of high cardiovascular and cerebrovascular events. From sleep to wakefulness, sympathetic nerve activity increases significantly, which leads to an increase in secretion of many hormones in the body during this time period, maximum blood viscosity, increased blood pressure, increased heart rate, increased heart contraction and increased oxygen demand. Many people with hypertension have a morning peak in their blood pressure, but not all of them need special treatment. If the blood pressure is not too high (e.g., high pressure <150 mmHg), it does not need special treatment if it falls quickly after activity. In terms of drug therapy, overcoming the morning peak phenomenon also requires us to finely regulate antihypertensive drugs, such as the use of long-acting antihypertensive drugs, taking fast-acting antihypertensive drugs when waking up in the early morning, dividing the day's medication into two doses and combining the application of drugs taken at different times, etc. 3, the seasonal changes in blood pressure: in winter the body in order to protect body temperature, reduce heat dissipation, capillary constriction, so that peripheral vascular resistance increases; low temperature, people sweat less, which will increase blood flow; cold diet increases, resulting in increased blood volume; in order to maintain body temperature, the body sympathetic excitation, causing increased cardiovascular function activity. These are the reasons for the increase in blood pressure in winter. Conversely, blood pressure tends to decrease in summer, and some patients, especially the elderly, even experience dizziness and discomfort due to low blood pressure. The best way to deal with seasonal fluctuations in blood pressure is to take regular blood pressure measurements and adjust medication according to the blood pressure. In summer, if blood pressure is too low, medication can be stopped for a period of time. The increase or decrease of antihypertensive drugs should pay attention to the speed, it is best to go to the hospital under the guidance of a doctor. 4, blood pressure fluctuations caused by special reasons: such as changes in blood pressure after mood swings, withdrawal or change of medication. Blood pressure fluctuations under special circumstances are a normal reaction of the body and do not need to be overly nervous. If the emotional tension due to the increase in blood pressure, it will cause a further increase in blood pressure, and the response of the drug is not good at this time, which is a vicious circle. At the same time, we should know that blood pressure does not return to normal immediately after the cause of blood pressure fluctuations is removed. Therefore, when blood pressure rises after mood swings, the main thing is to try to eliminate the trigger and balance the mind. If the blood pressure is too high temporarily take short-acting antihypertensive drugs, if necessary, sedation treatment. Withdrawal or change of medication is bound to cause blood pressure fluctuations, especially with long-acting drugs, and it takes some time for the efficacy to wear off as well as to take effect. Therefore, in the treatment of hypertension, if we find the right drug, do not change it too often, and do not adjust the drug too often. If you have to change your medication, you should have a good estimate of the fluctuation of blood pressure and take short-acting drugs for transition if necessary. In conclusion, our blood pressure is not static, and regular blood pressure measurement is the best way to detect fluctuations in blood pressure. When blood pressure fluctuates, the first step is to find the cause of the fluctuation, relax your mind, and if necessary, ask your doctor to help us analyze the cause and deal with it appropriately.