By Nancy Schimelpfening, MS
• New research suggests that taking your blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease.
• Timing of medication is important because blood pressure follows a daily rhythm. It rises higher during the day and falls at night when we sleep.
• Rather than taking a blanket approach, experts say any medication regimen should be personalized for you based on a discussion with your physician.
Should you be taking your blood pressure medication at bedtime rather than in the morning?
Research published in the October 22, 2019, issue of the European Heart Journal suggests that maybe you should.
In the study, the researchers followed 19,084 patients with high blood pressure for a median of 6 years.
The patients were randomly assigned to one of two groups: those who took their blood pressure medication in the morning and those who took it at bedtime.
The researchers found that bedtime medication seemed to make a difference for patients as they had better nighttime blood pressure.
They also had less risk of illness or death due to heart and blood vessel disease.
Why is the timing of your medication important?
According to AARP, blood pressure follows a daily rhythm. It rises higher during the day and falls at night when we sleep.
Since morning blood pressure is usually highest, people often opt to take their medications then. Many also feel that it is easier to remember morning medications.
Also, since many medications cause urination, people may prefer to take them early in the day.
As we age, however, we may develop a blood pressure pattern called non-dipping. Non-dipping blood pressure tends to remain high overnight.
People ages 55 and older with high blood pressure are more prone to non-dipping.
Non-dipping blood pressure is a problem because it is a major risk factor for several conditions, including heart attack, stroke, and kidney disease.
Overnight blood pressure control is important in order to lower your risk.
If your medication wears off before your next dose is due, your blood pressure may be elevated for several hours while you sleep. You may also wake with high blood pressure.
Taking your medication at bedtime may help prevent this issue.
Should you take your blood pressure medication at bedtime?
While it is generally believed that nighttime blood pressure medications are helpful for those with non-dipping blood pressure, this new study seems to indicate that it might be helpful in more effectively lowering blood pressure for a broader range of people.
Dr. Kim Williams, the head of the division of cardiology at Rush University Medical Center and past president of the American College of Cardiology, says he feels it’s too soon to begin recommending that all patients take their medications at bedtime.
“We need more data from other centers as much of the data favoring this come from a small set of investigators. Other trials and experience are not as strikingly positive,” he noted.
Williams added, “Speculation would hold that this is a good idea when the patient is known to have nocturnal hypertension but these authors suggest that it works for all comers. We clearly need more data.”
Dr. Satjit Bhusri, assistant professor of cardiology at Zucker School of Medicine at Hofstra/Northwell, also felt that it should not be a blanket recommendation for all patients.
There are many factors to consider, he says, such as:
• Do you have large swings in your blood pressure?
• Are you consistent and regular in taking your medication?
• What other medications are you taking?
Your medication regimen should be personalized for you based upon a discussion with your physician, says Bhusri.
However, Dr. Ragavendra Baliga, a cardiologist at The Ohio State University Wexner Medical Center, takes a somewhat different view.
“Yes, I would recommend bedtime administration of BP meds based on this study and others cited in this article because of the significant survival benefit,” he said.
“In my opinion this is particularly true in those patients with high BMI (and consequently more likely to have obstructive sleep apnea), elderly (since they have more insomnia), diabetics, and those with chronic kidney disease,” Baliga added.
What else can you do to better control your blood pressure?
Bhusri feels the key to controlling your blood pressure is your routine.
If your routine helps you take your medications regularly and consistently, then they will be more effective in controlling your blood pressure.
“It is well known that meds that are prescribed to take at night have a higher rate of consistency,” said Bhusri. “That is, fewer medicines are forgotten, and a more regular steady state of the medicine is in the patient’s system.
“Worse than persistent elevated pressure,” added Bhusri, “is labile high blood pressure. That is, swings in blood pressure for not adhering to the regimen.”
Bhusri believes that better compliance may have been the reason that the patients in the study had better blood pressure control.
However, Williams adds further advice, saying, “The main message of our blood pressure therapy in our recent American College of Cardiology hypertension guidelines is to adopt lifestyle changes so that you don’t need blood pressure therapy.
Among their recommendations, says Williams, are:
• Stop smoking.
• Reduce alcohol intake.
• Exercise regularly (over 150 minutes per week).
• Reduce excess weight.
• Reduce sodium.
• Increase potassium.
• Eat a diet rich in fruits, vegetables, nuts, seeds, and legumes.
Baliga also supports these lifestyle changes, adding to the list good sleep hygiene as well as an assessment for sleep apnea for at-risk patients.
The bottom line
New research suggests that taking blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease.
Timing of medication is important because blood pressure typically follows a daily rhythm. It often rises higher during the day and falls at night when we sleep.
Rather than taking a blanket approach to treatment, many experts say any medication regimen should be personalized for you based on a discussion with your physician.
Taking your medication regularly and making lifestyle changes can also have a large impact on managing your blood pressure.
*Credit: Health line *