Should You Take Your Blood Pressure Medication at Bedtime?

If you have chronic high blood pressure or hypertension, your doctor is going to prescribe blood pressure drugs to help lower high blood pressure and to keep it under control. There are several classes of high blood pressure medications, and they are available in a variety of drugs. New research has indicated that the best time for taking blood pressure medication is before bedtime at night, rather than taking them in the morning. So should you take your blood pressure medication at bedtime? Let us take a look.

Should You Take Your Blood Pressure Medication at Bedtime?

Taking your blood pressure medication at bedtime may significantly help in reducing the risk of disease or death due to blood vessel or heart disease.(1) New research suggests that not only does the timing of when you take your medication help control your blood pressure better, but it also dramatically lowers the risk of heart-related deaths and instances of heart attack and stroke.(2,3,4,5,6)

High blood pressure is known as the silent killer because it usually has no visible symptoms, but it is one of the leading risk factors for heart disease and stroke. Heart disease and stroke are amongst the number one causes of death in the United States alone, and according to the Centers for Disease Control and Prevention, around one in three adults in the US have high blood pressure.(7,8)

The time at which you take the medication is essential because of the fact that your blood pressure follows a daily rhythm. Generally, blood pressure is known to be higher during the day, with levels falling at night while we sleep. So instead of taking a broad approach to taking blood pressure medication at any time during the day, medical experts now suggest that any medication should ideally be personalized after discussing with your doctor.(9)

The 2019 study was published in the European Heart Journal. It suggested that taking your blood pressure medication at bedtime instead of in the morning will turn out to be more effective in managing your blood pressure.

The study followed 19,084 patients who had chronic high blood pressure for a period of six years. The participants were split into two groups, one who took their blood pressure medication at bedtime and those who took it in the morning. The authors of the study found that the participants taking their medication at night had better nighttime blood pressure. They were also found to have a reduced risk of illness or death due to heart disease.

Does Timing Of When You Take The Blood Pressure Medication Matter?

According to experts, blood pressure tends to follow a daily rhythm, and it remains on the higher side during the day and falls at night when it’s time to sleep.(10) It has been observed that people usually decide to take their blood pressure medication in the morning since morning blood pressure readings are generally the highest.(11) Most people also find it easier to remember to take their medicine in the morning.

  • People also prefer taking a majority of their pills earlier in the day since many medications cause increased urination.
  • As we age, though, many people on blood pressure medication end up developing a blood pressure pattern known as non-dipping.(12) When a person has non-dipping blood pressure, the levels tend to remain high overnight as well. People who are 55 years or older and have high blood pressure are more likely to suffer from non-dipping.(13)
  • The phenomenon of non-dipping blood pressure can be a problem since it is a significant risk for various health conditions, including stroke, heart attack, and kidney disease.(14,15)
  • Controlling blood pressure as you sleep is very important and necessary to lower your risk of many other health conditions.
  • Keeping this in mind, if your medication wears off before you are supposed to take your next dose, your blood pressure will likely be elevated for several hours while you are sleeping, and you are more likely to wake up with high blood pressure. This is how taking your blood pressure medication helps prevent this from happening.

So Should You Be Taking Your Blood Pressure Medication at Bedtime?

The new study has provided several new insights into taking your blood pressure medication at bedtime. While earlier it has been widely believed that for people with non-dipping blood pressure, taking their blood pressure at nighttime was more helpful, the new study now indicates that this might be helpful in lowering blood pressure for a broader range of people.

However, with just one study to indicate this, it might be too soon to make sweeping changes to medication routines and begin recommending that all patients start taking their medications at bedtime. Changing of medication timing also depends on specific individual circumstances and any other underlying health condition a person might be having.

There is a need for more research before changing over to a new medication regimen.

At the same time, exercising regularly, eating a healthy diet, quitting smoking, avoiding excessive drinking of alcohol, reducing the intake of sodium (salt) in your diet, cutting back on caffeine, reducing your stress, losing the extra pounds and watching your waistline, and regularly taking your blood pressure medication can help you maintain a better control over your blood pressure levels.

Conclusion

New research has found that taking your blood pressure medication at nighttime rather than in the morning may be more effective in reducing the overall risk of illness or death due to heart disease. The study firmly established that the timing of medication is very important since blood pressure tends to follow a daily rhythm.

However, due to a lack of more research on the subject, doctors recommend personalizing blood pressure medication regimen based on individual conditions.

Taking your blood pressure medication regularly and also making healthy lifestyle changes can help you manage your blood pressure more effectively, and also reduce the risk of heart disease in the long run.

References:

  1. Kannel, W.B., 1996. Blood pressure as a cardiovascular risk factor: prevention and treatment. Jama, 275(20), pp.1571-1576.
  2. Hermida, R.C., Crespo, J.J., Domínguez-Sardiña, M., Otero, A., Moyá, A., Ríos, M.T., Sineiro, E., Castiñeira, M.C., Callejas, P.A., Pousa, L. and Salgado, J.L., 2019. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. European heart journal.
  3. Stamler, J., Stamler, R. and Neaton, J.D., 1993. Blood pressure, systolic and diastolic, and cardiovascular risks: US population data. Archives of internal medicine, 153(5), pp.598-615.
  4. Weir, M.R., Maibach, E.W., Bakris, G.L., Black, H.R., Chawla, P., Messerli, F.H., Neutel, J.M. and Weber, M.A., 2000. Implications of a health lifestyle and medication analysis for improving hypertension control. Archives of internal medicine, 160(4), pp.481-490.
  5. Cushman, W.C., Ford, C.E., Cutler, J.A., Margolis, K.L., Davis, B.R., Grimm, R.H., Black, H.R., Hamilton, B.P., Holland, J., Nwachuku, C. and Papademetriou, V., 2002. Original Papers. Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The Journal of Clinical Hypertension, 4(6), pp.393-404.
  6. MacMahon, S., Peto, R., Collins, R., Godwin, J., Cutler, J., Sorlie, P., Abbott, R., Neaton, J., Dyer, A. and Stamler, J., 1990. Blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. The Lancet, 335(8692), pp.765-774.
  7. Cdc.gov. 2020. Faststats. [online] Available at: <https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm> [Accessed 12 June 2020].
  8. Centers for Disease Control and Prevention. 2020. Facts About Hypertension | Cdc.Gov. [online] Available at: <https://www.cdc.gov/bloodpressure/facts.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdhdsp%2Fdata_statistics%2Ffact_sheets%2Ffs_bloodpressure.htm> [Accessed 12 June 2020].
  9. Cooper-DeHoff, R.M. and Johnson, J.A., 2016. Hypertension pharmacogenomics: in search of personalized treatment approaches. Nature Reviews Nephrology, 12(2), p.110.
  10. Simon, N., 2020. When You Take Your Daily Medications May Be Key. [online] AARP. Available at: <https://www.aarp.org/health/drugs-supplements/info-12-2013/timing-of-daily-medications-key.html#quest1> [Accessed 12 June 2020].
  11. Bloodpressureuk.org. 2020. Blood Pressure : Q. Is There A Best Time To Take My Tablets?. [online] Available at: <http://www.bloodpressureuk.org/microsites/u40/Home/treatments/Whenisbest> [Accessed 12 June 2020].
  12. Simon, N., 2020. When You Take Your Daily Medications May Be Key. [online] AARP. Available at: <https://www.aarp.org/health/drugs-supplements/info-12-2013/timing-of-daily-medications-key.html#quest1> [Accessed 12 June 2020].
  13. Kario, K., Shimada, K. and Pickering, T.G., 2003. Abnormal nocturnal blood pressure falls in elderly hypertension: clinical significance and determinants. Journal of cardiovascular pharmacology, 41, pp.S61-S66.
  14. Zweiker, R., Eber, B., Schumacher, M., Toplak, H. and Klein, W., 1994. ” Non-dipping” related to cardiovascular events in essential hypertensive patients. Acta Medica Austriaca, 21(3), pp.86-89.
  15. Sturrock, N.D.C., George, E., Pound, N., Stevenson, J., Peck, G.M. and Sowter, H., 2000. Non‐dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus. Diabetic Medicine, 17(5), pp.360-364.

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