High blood pressure meds work best when taken at bedtime

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.

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.”

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 who were randomly assigned to take their blood pressure-lowering medications first thing in the morning or at bedtime.

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.