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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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Taking These Medications At Bedtime Rather Than In The Morning May Make Them More Effective
Many people take their medications as part of their morning ritual, along with a cup of coffee and the daily newspaper. But for blood pressure drugs, evening may be a better option. Last year, a large study found that taking blood pressure drugs before bed may lower the risk of serious heart-related complications more than taking the drugs in the morning .
The concept of chronotherapy, or adjusting medication dosing to a specific time of day, isn’t new. There’s not a great deal of evidence to support the practice with cardiovascular drugs, but it makes sense, says Dr. Naomi Fisher, director of the Hypertension Specialty Clinic at Harvard-affiliated Brigham and Women’s Hospital.
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When Is The Best Time Of Day To Take Blood Pressure Medication
People diagnosed with high blood pressure tend to take their medication in the morning. Since your heart rate and blood pressure are usually higher when waking up and lower when you sleep, this timing seems to make sense.
However, current research is increasingly pointing toward taking these medicines at bedtime. This is especially true from the angle of chronotherapy, an approach based on your body’s natural cycle of physical changes every 24 hours, referred to as your circadian rhythm.
Health experts have also used this approach to determine the best timing to effectively treat other conditions like diabetes, chronic kidney disease, and sleep apnea.
A new study in Spain also suggests that taking high blood pressure medication at night is more effective than in the morning. The HYGIA chronotherapy trial³ included 19,168 patients aged 60 or older. Half of the patients took blood pressure medicines before bedtime the other half when they woke up.
Results showed that those who took medicines before bedtime controlled their blood pressure level better than those who took them at the other end of the day. They also had a 45% lower risk of heart-related illnesses or death.
A close assessment showed that taking medication at night reduced the risk of:
-
Heart attack by 44%
-
Heart failure by 42%
This is the longest, largest trial examining the effects of different timings of antihypertensive medication on the possible risks of heart disease.
When Is The Best Time To Take Your Blood Pressure Medication
Day or night – when is the best time to take your blood pressure medication?
A major study has revealed that taking blood pressure medication at bedtime rather than on waking halves the risk of events such as heart attack and stroke.
It’s a simple tip that could save lives, researchers of the study say in the European Heart Journal.
There is mounting evidence that many different drugs, including heart pills, might work better when taken at specific times of the day and experts believe our body’s biological ‘clock’ or natural 24-hour rhythm alters our response to the medication.
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
The research suggests taking medication in the evening helps keep night-time blood pressure in check, in patients diagnosed with high blood pressure .
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.
Read Also: How To Reduce The Blood Pressure
What Did It Find
- Over an average 6.3 years of follow-up, 9% of patients experienced one of the main cardiovascular outcomes of interest: heart attack, revascularisation procedure, heart failure or stroke, or related death.
- Patients taking their medications at bedtime had 45% reduced risk of this composite outcome hazard ratio 0.55, 95% confidence interval 0.50 to 0.61 .
- Patients taking medication at bedtime also had reduced risk of all individual outcomes assessed, including cardiovascular death , heart attack , revascularisation procedure and ischaemic stroke due to a clot . The only exception was a transient ischaemic attack , which was not statistically significant.
- 48-hour blood pressure monitoring demonstrated that both systolic and diastolic blood pressure dipped lower during the night for patients taking their medication before bed. There was no difference in daytime blood pressure.
- There was no difference in the frequency of adverse effects , or patient adherence to the allocated treatment schedule .
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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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.”
Show Sources
European Heart Journal
When Is The Best Time To Take Your Blood Pressure Meds
- https://www.aarp.org/health/conditions-treatments/info-2019/blood-pressure-medication-bedtime.html
- It normally dips at night and rises in the morning. Then, by the afternoon, it starts to go down again. This natural rhythm helps to explain why taking medicine to lower blood pressure may work best when done at night. “It better targets the morning rise in blood pressure,â Osborne said. Whereas, âif you take your blood pressure medicine in …
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What Are The Implications
This trial builds on previous research findings, adding strength with its large sample size and long duration of follow-up. This was a well-conducted trial in primary care, and it was not possible to analyse whether there may be a difference according to drug regimen and/or associated patient characteristics.
The findings seem to provide strong evidence. Unless there is a reason to take antihypertensive medications at another time of the day, taking them at bedtime may be beneficial and is not expected to cause harm.
Bedtime Bp Meds May Cut Heart Risk By Almost Half : Large Randomised Study
Blood pressure medication may confer a larger benefit if taken at night, rather than in the morning. A robust Spanish study of more than 19 000 patients found that taking the medication so that it works overnight 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 studys lead author, Ramon Hermida, director of the Bio-engineering and Chrono-biology Labs at the University of Vigo in Spain.
NBC News reports Hermida and his research team randomly selected half of the study participants to take their blood pressure pills upon waking up in the morning. The other half made the medication part of their bedtime routine. The team then tracked the patients for six years, periodically monitoring their blood pressure levels continuously in 48-hour blocks.
The report says previous studies had hinted that better blood pressure control at night might offer a benefit. This was the piece that was missing, Dr Renato Lopes, a professor of medicine at Duke University School of Medicine, said. For the first time in a very large, randomised fashion, this study really gave us impressive results, said Lopes, who was not involved in the research.
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