What is the best time of the day to take hypertension medicine?

When people take their hypertension medications at bedtime, blood pressure is better controlled during the night and the risk of death or illness due to cardiovascular disease is significantly lowered, a new study suggests

doctor checking patients blood pressure
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Spanish researchers who followed nearly 20,000 patients for a median of six years found that patients who took their medications at bedtime cut their overall risk of dying from cardiovascular causes during the study nearly in half compared with those taking the drugs in the morning, according to a report in European Heart Journal.

“The time of day when you take your blood pressure-lowering medication counts,” said lead author Ramon Hermida, a professor and director of the bioengineering and chronobiology labs at the University of Vigo.

“Beyond greater reduction of asleep blood pressure – the most significant marker of cardiovascular disease risk – the mechanisms involved so far are just hypothesis, mainly dealing with well-documented circadian rhythms in determinants of around-the-clock blood pressure variability,” Hermida said in an email. “The beneficial effects of bedtime therapy on (kidney) function and lipid profile documented in our study may also play a significant role.”

With earlier studies showing mixed results, Hermida’s team designed a large randomized study that could provide conclusive evidence on whether it made a difference when blood pressure medications were taken. They recruited 19,084 hypertensive patients – 10,614 men and 8,470 women – who were randomly assigned to take their blood pressure-lowering medications first thing in the morning or at bedtime.

The volunteers all wore ambulatory blood pressure measuring devices, which kept track of blood pressure 24 hours a day.

The researchers found, after accounting for factors like age, gender, type 2 diabetes, chronic kidney disease, smoking, cholesterol levels and previous cardiovascular events, that it made a big difference when patients took their medications.

At their final evaluation, patients who took their medications at night had significantly lower LDL cholesterol, higher HDL cholesterol and lower sleeping blood pressure.

During follow-up, 3,246 volunteers experienced a cardiovascular event: 274 had heart attacks, 302 had procedures to open clogged arteries, 521 were diagnosed with heart failure, 345 had a stroke and 310 died from a cardiovascular cause.

Risk of these events, and of dying from them, was significantly lower in the bedtime group. Those who took their medications at bedtime were 45% less likely to die of cardiovascular causes overall, 56% less likely to die of cardiovascular disease, 61% less likely to die of hemorrhagic stroke and 46% less likely to die of ischemic stroke – the more common kind.

Those taking medications at bedtime were also 34% less likely to have a heart attack, 40% less likely to need a procedure to widen clogged arteries, 42% less likely to develop heart failure and 49% less likely to have a stroke.

While speaking to My Medical Mantra, Dr Hemant Kokane, a consultant cardiologist from Sassoon Hospital, Pune, informed, “The findings of the study are true. It is not a myth. Blood pressure medications have a 24-hour effect. We as doctors advise patients to take their medicine at night. There are two reasons for this. The first one is that any possible side-effects are masked by sleep. The body responds to the medicine in an efficient manner.”

He added, “The other reason is that it helps prevent a surge of blood pressure from occurring in the morning. There are chances that blood pressure can spike during the early hours of the morning. Taking the medication at night prevents this from happening.”

Medications tend to be most effective for three to 15 hours, so if you take them in the morning, they’re clearly wearing off during the most important hour.

While speaking to My Medical Mantra, Dr Nagesh Waghmare, a cardiologist and associate professor from Mumbai’s Sir JJ Hospital, said, “Through the 24-hour ambulatory blood pressure monitoring we came to know that blood pressure during the nighttime remains undetected as doctors examine patients during the daytime. When medicines are taken in the morning, their effects last for around 20 hours and they fail to cover the early hours of the morning. This increases the risk of heart attacks and strokes due to the sudden surge in blood pressure.”

He informed, “In my clinical practice, I advise patients to take their medicine around 6 to 7pm. It is advisable to take some medicines in the evening. The study has now proven this.”

Source: Reuters Health