@unmanageable I have no side effects from hydralazine and I take 50mg twice a day. If I get a spike in the afternoon, I can take an additional 50mg. It is a pretty high dose but I tolerate it just fine. Good luck - mention cardiology to your GP. Mine sent me to endocrinology for a workup due to so many spikes (one sending me to ER). Now if I have one, it is seldom and not terribly high. They added a very small dose of an alpha blocker as well. I hate all these meds but as long as I don't have side effects, I'll do what I need to.