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Blood Pressure Drugs: Is Timing Key
Study Shows Switching Treatment From Morning to Night May Help Some Patients
Dec. 13, 2007 — Switching the timing of blood pressure medications might help patients with kidney disease avoid life-threatening complications, a new study suggests.
Researchers in Italy report that switching the dose of one blood pressure drug from morning to night helped restore normal nighttime blood pressure patterns in patients with abnormal patterns at night.
In most people, blood pressure normally drops by at least 10% at night, usually between midnight and 3 a.m. The researchers noted that patients with chronic kidney disease who do not experience this normal nocturnal dip have been shown to be at increased risk for kidney failure, heart attack, and stroke, according to the researchers.
With this in mind, researchers from the Second University of Naples tweaked the timing of blood pressure drug delivery to see if they could change nighttime blood pressure patterns.
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Bedtime May Be The Best Time To Take Blood Pressure Meds Study Finds
Blood pressure medication may confer a larger benefit if taken at night, rather than in the morning, according to research published Tuesday in the European Heart Journal.
The large study of more than 19,000 high blood pressure patients found that taking the medication so that it works overnight, when patients are asleep, cuts the risk of heart-related death and disease nearly in half.
“The same medication ingested at different times of the day actually has different pharmacological properties, behaving like totally different medications,” said the study’s lead author, Ramón Hermida, director of the Bioengineering and Chronobiology Labs at the University of Vigo in Spain.
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There is mounting evidence that many different drugs, including heart pills, might work better when taken at specific times of the day.
This latest trial is the largest so far to look at the phenomenon with high blood pressure pills, and included more than 19,000 people on these medications.
In the Spanish study:
- The patients were put into two groups at random – one group took the pills in the morning and the other group took them at bedtime
- Researchers monitored what happened to the patients over the next five or more years
- Patients who took their medication in the evening had nearly half the risk of dying from – or having – a heart attack, stroke or heart failure
Blood pressure should naturally dip at night, as we rest and sleep.
If it doesn’t, and remains consistently high, that puts you at increased risk of heart attacks and strokes, experts say.
The research suggests taking medication in the evening helps keep night-time blood pressure in check, in patients diagnosed with high blood pressure .
Patients in the study who took their medication at bedtime had significantly lower average blood pressure both at night and during the day, and their blood pressure dipped more at night, when compared with patients taking their medication each morning.
Lead researcher Prof Ramon Hermida, from the University of Vigo, said doctors might want to consider recommending it to patients: “It’s totally cost-free. It might save a lot of lives.
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Should I Take My Blood Pressure Medication At Night
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Doctors often suggest taking daily medication in the morning, as part of your start-the-day routine. A recent study, however, suggests that taking your blood pressure medicines at night may offer important cardiovascular protective benefits. Dr. Allen J. Taylor, chairman of cardiology at MedStar Heart and Vascular Institute, gives us his thoughts on the study and what patients should know.
This large study, recently published in the European Heart Journal, certainly caught my attention. The eye-opener: study patients who took their prescribed blood pressure medicines at bedtime had a dramatically lower risk for serious cardiovascular conditions and death than people taking their medicines in the morning. Besides better controlling their blood pressure overall, patients who dosed at night experienced:
- 56% lower risk of death due to heart or blood vessel conditions
- 49% lower risk of stroke
- 34% lower risk of heart attack
- 40% lower risk of needing surgery to open or widen a vessel supplying blood to the heart
These impressive results seem almost too good to be true and, like all studies, the benefits should be validated and confirmed with more studies. Still, its large size and long duration give this current study considerable credibility.
What Did This Study Do
The Hygia Chronotherapy randomised controlled trial was conducted across 40 general practices in Northern Spain as part of a larger project looking at ambulatory blood pressure measurement. Over 10 years, 19,168 adults taking one or more anti-hypertensive medications were randomised to take them in the morning or at night.
Average patient age was 61 years, 56% were male, 43% had obesity, 24% type 2 diabetes, 29% chronic kidney disease, and 10% had previously had a cardiovascular event.
In total, 53% were taking angiotensin receptor blockers , 25% ACE inhibitors, 33% calcium channel blockers, 22% beta-blockers and 47% diuretics. ARBs or ACE inhibitors were the most common single therapies, with the addition of a diuretic or calcium channel blocker the most common dual combinations.
Patients were followed up by clinical assessments and 48-hour ambulatory blood pressure monitoring at least annually. The outcome assessors were unaware of group allocation.
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Day Or Nightwhen Is The Best Time To Take Your Blood Pressure Medicine
ANKARA, TURKEY – NOVEMBER 14: A woman takes a pill on November 14, 2018 in Ankara, Turkey.
Getty Images
If you have high blood pressure, remembering to take your medication is so important.
In fact, the time of day when you take your medicine could influence your risk for complications such as heart attack and stroke, which is ultimately related to how well you manage your blood pressure.
The bodys natural rhythm, known as the circadian rhythm also affects how we respond to specific medications, the result of a complex interplay between your medication and cortisol, the chief hormone responsible for this rhythm.
Now, a new study recommends that you take your blood pressure medicine at bedtimeto lower your blood pressure during the night and early morninghelping to prevent elevation of blood pressure that normally occurs as you awaken.
The research was published earlier this week in the European Heart Journal.
There is a growing body of evidence which indicates that not only genetics, but the time of day you take a medicine may influence how effective it is for treating a particular condition.
The current study looking at this phenomenon represents the largest study to date of patients with high blood pressure, and included more than 19,000 persons on medications to treat high blood pressure.
The key here is routines, said Bhusri. An even routine has shown that patients are more compliant with taking their medications more regularly and not forgetting.
Taking Blood Pressure Pills At Bedtime Best For Cardiovascular Health
New research suggests that the best time for people with hypertension to take their blood pressure pills is at bedtime rather than in the morning.
It appears that not only does this timing result in better blood pressure control, but that it also markedly reduces the risk of cardiovascular death and events such as a heart attack or stroke.
Researchers came to these conclusions after analyzing data from the Hygia Chronotherapy Trial.
Hygia is the largest and longest lasting clinical trial to examine the effects of antihypertensive medication timing on the risk of cardiovascular events.
The investigators behind the present findings randomly assigned 19,084 adults to take the blood pressure pills that their doctors had prescribed either when they woke up in the morning or at bedtime. The participants were of Caucasian Spanish descent, and 8,470 were female.
During an average follow-up of 6 years, all individuals underwent 48-hour ambulatory blood pressure monitoring at least once per year.
The results of this study, says Ramón C. Hermida, Ph.D., the leader of the Hygia project, show that patients who routinely take their antihypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems.
He and colleagues report the recent findings in the European Heart Journal.
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Advantages Of Medicating At Night
Quite a few studies suggest that blood pressure medications may work best when taken at night.
The biggest and most significant of these was the Hygia Chronotherapy Trial. It was a six-year study of more than 19,000 people with high blood pressure.
The researchers divided the participants into two groups. One group took their blood pressure medication in the morning. The other took them at night. At least once a year, all of the participants used ABPM to record their blood pressures.
The researchers found that when compared to the morning group, those who took their blood pressure treatment at night had a lower risk of getting a number of conditions.
For the nighttime medication group:
- The risk of stroke was lower by 49%.
- The risk of heart attack was lower by 34%.
- The risk of heart failure was lower by 42%.
A 2015 study in the journal Diabetologia found that taking these medications at night reduced the risk of type 2 diabetes for people with high blood pressure. Other studies report possible advantages of taking blood pressure medication at night. One is that many people are more likely to take their medication before bed rather than in the morning. Another is that the effects of these treatments may wear off more slowly when they are taken at night than when people take them in the morning.
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So who has the power to decide whether your future is happy when should a person take blood pressure medicine or unfortunate There is only one grade 1 hypertension answer.
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Bedtime May Be Best Time For Blood Pressure Meds
By Alan Mozes HealthDay Reporter
WEDNESDAY, Oct. 23, 2019 — Taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure, a large, new study finds.
Researchers in Spain followed more than 19,000 adults with high blood pressure. They found that people who took all their blood pressure meds at night had lower blood pressure around the clock compared to volunteers who took their medication in the morning.
“The findings are highly consistent regardless of sex, age, presence of diabetes or kidney disease, and other major known factors of increased risk,” said study lead author Ramon Hermida.
Hermida is director of bioengineering and chronobiology at the University of Vigo’s Atlantic Research Center for Information and Communication Technologies.
“Conventionally, most patients ingest their medication in the morning,” said Hermida, “although no single trial ever documented this to be preferable.” No guidelines are currently in place regarding the best time to take the drugs, he added.
A New York City heart doctor believes consistency in taking your blood pressure pills will deliver optimal protection.
“The key here is routines,” said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital. “Not missing a dose. We know one thing worse than an elevated blood pressure is swings in blood pressure due to periodic non-compliance.”
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European Heart Journal
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