Best time to take your blood pressure medication – Day vs Night

Hypertension or raised blood pressure is a chronic condition, usually requiring lifelong treatment to keep numbers under the safe limit.

Uncontrolled blood pressure predisposes to several other conditions including Heart Attack, Stroke, Kidney failure and vision loss.
Early diagnosis and prompt treament saves the serious complications resulting from sustained high pressures.
Anti-hypertensive medication (blood pressure lowering pills) are a standard therapy. With current regimens recommeding single or multiple medications in a combined tablet usually taken once a day. This is because the single dose is enough to last the whole day. Earlier guidelines didn’t fix an appropriate timing for the medication apart from taking the dose the same time each day.
The effect of fixed timing of anti-hypertension medication was recently studied in a research trial, which compared daytime vs night time dose and the overall blood pressure control.
A Spanish team randomized more than 19,000 primary care patients with hypertension to  take their medication regimen either at bedtime or on awakening. At baseline, the two groups  exhibited similar blood pressure levels and pertinent physiological, comorbidity, and laboratory  (e.g., LDL cholesterol) values. Patients were followed rigorously (e.g., repeated 48-hour ambulatory  BP measurements at least annually) during a 6.3-year median follow-up.
Blood pressure (BP) during sleep predicts cardiovascular (CV) outcomes better than daytime  pressure. Peak activity of the renin-angiotensin system is greatest during sleep, and circadian  rhythms influence the pharmacokinetics of many BP drugs.
The results showed Daytime and nighttime BPs were significantly lower in the bedtime group than in the awakening  group. There was a relative risk reduction of 50% , with no significant adverse effects.
The purpose of sharing this research is to highlight the fact that night time dosing of blood pressure medication should be recommnded, the risk reduction and risk benefit achieved from such a simple intervention is quite cost-effective. Though this study didn’t get the much needed publicity as the new fancy medications get, the results are nonetheless promising.
Reference: [Hermida RC et al. Bedtime hypertension treatment improves cardiovascular risk reduction: The Hygia Chronotherapy  Trial. Eur Heart J 2019 Oct 22; [e-pub]. (]
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