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Blood Pressure Medications May Work Better When Taken at Night

November 21, 2019

A new study published in the European Heart Journal found that taking blood pressure medications at bedtime may be more beneficial than taking the drugs in the morning.

“There is no apparent downside to moving blood pressure medicines from morning to bedtime,” said Brandon William Calenda, MD, non-invasive cardiovascular specialist with Atlantic Medical Group.

Known as the Hygia Chronotherapy Trial, the Spanish study involved more than 19,000 people with high blood pressure.  Approximately half took their medications first thing in the morning, while the other half took their blood pressure drugs before going to bed.   Participants were followed for approximately six years.  

Patients who took their medications at bedtime showed a lower risk of heart attack, heart failure and stroke.

“This study is notable for a remarkably safe intervention that may be very powerful,” said Dr. Calenda. “The notion that taking one’s blood pressure medications before bedtime (as opposed to the morning) could reduce mortality, heart attacks, and strokes is quite surprising.” 

Dr. Calenda added: “Even though the overall magnitude of blood pressure lowering was small, the clinical effect was not. The magnitude of reduction in meaningful events is impressive, and at the end of the day, reducing heart attacks and strokes is one of the major goals of blood pressure medicines.”

The study’s authors also found that participants who took their medications at bedtime had better blood pressure control while they slept. Blood pressure is normally higher during the daytime and lower at night, while sleeping. Those with high blood pressure, and older people in general, do not experience “dipping” nighttime blood pressure, which places them at higher risk for heart disease and stroke.  Study participants taking blood pressure medications at night did experience lower nighttime blood pressure, however, decreasing their cardiovascular risk. 

“What this study points out to me is how little we understand about sleep and its relation to blood pressure control,” Dr. Calenda said.  “Many blood pressure hormones are synthesized at night, and it seems the normal drop in blood pressure at night may be much more important than previously realized. Nighttime blood pressure medicines seem to facilitate this decrease.” 

Most study participants were in their sixties or early seventies, with slightly more men than women participating. The study was conducted at multiple sites in Spain.