Taking some medications at specific times of the day can help them work better. In this report by SADE OGUNTOLA, experts suggest that some blood pressure pills taken at night might improve blood pressure and prevent more heart attacks and strokes than taking the same medications during the day.
There are many different high blood pressure medications (antihypertensives) available, each with pros and cons. And the doctor might prescribe more than one type to treat the condition because how well a drug works can depend on age, sex, race, blood pressure level and overall health.
Medication can help to prevent possible long-term health consequences of high blood pressure, such as heart attacks and strokes. Because the various medications are equally effective at lowering blood pressure, it’s often possible to find one that is well tolerated.
There is mounting evidence that many different drugs, including high blood pressure medications, might work better when taken at specific times of the day.
This is particularly now that the latest trial on these medications says that taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure.
Researchers in Spain had followed more than 19,000 adults with high blood pressure. They found that people who took all their blood pressure medications at night had lower blood pressure round the clock compared to volunteers who took their medication in the morning.
The study results were published on-line October 22 in the European Heart Journal.
The investigation — called the Hygia Chronotherapy Trial — ran between 2008 and 2018. It involved about 10,600 men and 8,500 women in northern Spain, aged 18 and older.
Study participants were randomly assigned to take all of their blood pressure pills just once a day, either in the morning or at bedtime. They had been diagnosed with high blood pressure before the study started. They were all tracked for a little over six years on the average.
Blood pressure was repeatedly assessed throughout the study. At least once a year, participants also wore a mobile monitor, which logged multiple blood pressure readings over two days.
In the end, the investigators found that those who always took their medications at bed time saw their risk of dying as a result of heart or blood vessel problems reducing by two-thirds, compared with those who always took them in the morning.
The researchers reported that a bedtime drug regimen was also linked to a 44 per cent reduction in heart attack risk; a 40 per cent reduction in the risk for surgery to unblock narrowed arteries (coronary revascularisation); a 42 per cent lower risk for heart failure; and a 49 per cent in stroke risk.
Overall, the yearly 48-hour mobile blood pressure readings showed that patients who took their medications at night had “significantly reduced” blood pressure while asleep, compared with their peers who followed a morning medication routine.
Howbeit, Dr Abiodun Adeoye, a consultant cardiologist, University College Hospital (UCH), Ibadan, said all high blood pressure medications are not created equally and as such individuals with hypertension should still talk to their doctor about the best time to take their medications.
According to Dr Adeoye, “you cannot take at night anti-hypertensive medication like diuretics. If you do, the patient will not sleep and if you are not sleeping, the blood pressure will not get regulated.”
Current guidelines on the treatment of hypertension do not mention or recommend any preferred treatment time. But for diuretics, morning ingestion has been the most common recommendation to avoid frequent urination disturbing sleep.
Diuretics, also called water pills, removes excess water and sodium from the body, so there’s less fluid flowing through the veins and arteries. This reduces pressure on the walls of the blood vessels.
Dr Adeoye, however, said taking blood pressure medications at bedtime is better only when hypertension goes hand in hand with other conditions such as kidney disease, diabetes, heart attack or stroke and heart failure.
He added “What we advocate is that if taking diuretics, take it in the morning and the other ones like ACE (angiotensin-converting enzyme) inhibitors and calcium channel blockers (CCBs) can be taken at bedtime.”
Moreover, older people need to be careful about taking blood pressure pills at night. Standing up too quickly in the middle of the night can lead to a sudden blood pressure drop and a fall.
All classes of antihypertensive drugs are designed to prevent long-term effects of high blood pressure. The suitability of a medication will depend on various factors, including the presence of any other medical condition, skin colour, sex and age.
Many people only have to take one type of medication to successfully lower their blood pressure. Others may also need a second or third blood pressure pills. Using a combination of medicines is more effective because each one works in a different way.
ACE inhibitors affect the production of the body’s hormones that are responsible for regulating blood pressure levels. To do this, they block a particular enzyme that plays a role in making angiotensin, a hormone which increases blood pressure.
Beta blockers reduce blood pressure by slowing down the pulse and protecting the heart from stress hormones while calcium channel blockers (CCBs) expand the blood vessels. This gives the blood more room to flow freely, thereby lowering blood pressure.
Now, some experts believe the body’s biological ‘clock’ or natural 24-hour rhythm alters the response to the medication. In most people, blood pressure begins to rise just before getting out of bed in the morning and reaches its peak around mid-day.
It falls during sleep, reaching its lowest point of day between midnight and 3:00 or 4:00 am. This drop is sometimes called “dipping.” But people with high blood pressure often have little or no decrease in their blood pressure at night.
Scientists cannot yet explain why taking the mediation before bed has such a profound effect, but they know that a high blood pressure level while a person is asleep is often a bigger indicator of heart disease risk.
Up until now, doctors suggest that the most important thing is to pick a particular time in the day to take high blood pressure medicine every day. Besides compliance, factors such as emotions and simultaneous use of other medications can affect a drug’s effectiveness.
Some advise patients to take the drugs in the morning as soon as they wake up. They believed reducing morning blood pressure levels is critical for preventing a stroke. But there is no proof to back this up.
Also, further research among other ethnic groups and people who work shift patterns would be needed to truly prove if taking blood pressure medication at night is more beneficial for cardiovascular health.
Lifestyle changes can also help to reduce or eliminate the need for medication. These include:
- Eating a healthy diet with plenty of fruits and vegetables and reducing the amount of sodium in your diet.
- Maintaining a healthy weight.
- Exercise. Get 30 minutes of moderate activity on most days of the week. It’s okay to break up the activity into three 10-minute sessions a day.
- Limit the amount of alcohol intake.
- Abstain from smoke.
- Manage stress.