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Background: Summertime dips in blood pressure (BP), both in normotensive and hypertensive subjects, are well known. However, the dips are small and are not related to particular forms or doses of antihypertensive medication. Nevertheless it is the practice in some quarters to decrease antihypertensive medication in summer, and/or to increase in winter. Large scale studies being inconclusive, there are calls for long-term examination of the relationship between environmental temperature and blood pressure in single individuals under medication.
Case presentation: While analyzing data from a subject whose BP had been controlled for a decade with the angiotensin-II receptor blocker losartan, an extreme, dosage-dependent, summertime dip came to light. Downward dosage adjustment appeared essential and may have prevented hypotension-related pathology.
Conclusion: The benefits of aggressive medication (the "J curve" phenomenon) being debated, the possibility of seasonal hypersensitivity, explicable in terms of differential signaling by countervailing receptors, should be taken into account when considering dosage adjustments in hypertensive subjects.
Version 3. The paper was submitted to BMC Research Notes in April 2014 and a decision on acceptability has not yet been reached (March 2015). In the interim, data for 2014 has become available and, together with fresh references, have been incorporated into the figures and text of the present version.