Should I Take My Blood Pressure Medication at Night?

Doctors often suggest taking daily medication in the morning, as part of your start-the-day routine. A recent study, however, suggests that taking your blood pressure medicines at night may offer important cardiovascular protective benefits. Dr. Allen J. Taylor, chairman of cardiology at MedStar Heart and Vascular Institute, gives us his thoughts on the study and what patients should know. 

This large study, recently published in the European Heart Journal, certainly caught my attention. The eye-opener: study patients who took their prescribed blood pressure medicines at bedtime had a dramatically lower risk for serious cardiovascular conditions and death than people taking their medicines in the morning. Besides better controlling their blood pressure overall, patients who dosed at night experienced:

• 56% lower risk of death due to heart or blood vessel conditions
• 49% lower risk of stroke
• 42% lower risk of heart failure
• 34% lower risk of heart attack
• 40% lower risk of needing surgery to open or widen a vessel supplying blood to the heart

These impressive results seem almost too good to be true and, like all studies, the benefits should be validated and confirmed with more studies. Still, its large size and long duration give this current study considerable credibility.

The research included more than 19,000 adults with hypertension in a randomized study, including approximately 8,500 women and 10,500 men living in northern Spain. The patients’ average age was 60, and they were monitored for a median of 6.3 years, with half assigned to taking all their blood pressure medications upon waking and half assigned to the bedtime regimen. Researchers also helped to ensure other factors weren’t responsible for the study results by controlling for known heart-health risks, such as age, gender, cholesterol levels, smoking status, and type 2 diabetes.

Interestingly, an earlier study by this research team, including about 2,100 patients, found that shifting even one blood pressure medicine to bedtime also lowered their heart health risks to some degree.

The potential benefit of taking blood pressure medicines at bedtime does make sense based on how a healthy body works. Blood pressure naturally rises and falls throughout the day. It surges when you wake in the morning, along with hormones and other substances. At night, when you’re sleeping, it typically drops to its lowest level. People with hypertension, however, often have little or no nighttime dip, which can be a risk factor for heart trouble. Taking your blood pressure medicine before bedtime could help ensure that a healthy nighttime dip does occur. That, in turn, may trigger or provide some restorative or protective effects to the heart that are not yet clearly identified.

This study did have some limitations worth noting. For instance, the types of prescribed medicines were not assessed or controlled in this study; in other words, each patient—hailing from one of 40 medical centers in Northern Spain—took what their own doctor had prescribed. In addition, it’s possible that the dramatic results seen in this study might not extend to people of other ethnicities.

However, there appears to be no risk or downside to taking your blood pressure medicines at night. In fact, it may be a smart move, as long as you remember to take them regularly. We do know that staying on track with taking your medicines is of utmost importance for getting the best possible results from them.

Takeaway 

Ask your doctor whether taking your blood pressure medications—or at least some of them—at bedtime might be a good idea for you, to help better control your blood pressure and lower your risk for serious heart-related problems.