Should You Take Your BP Meds at Bedtime?

Researchers at the Chronobiology Laboratories at the University of Vigo, Spain, have studied the effects of hypertensive patients taking at least one of their blood pressure meds at bedtime, rather than in the morning.  The results of their work are published in the Journal of the American Society of Nephrology.

More than 650 patients with chronic kidney disease who were taking antihypertensive medication were allocated to take all their blood-pressure meds on waking up or to take at least one of them at bedtime.  48-hour blood pressure recordings were made at baseline, 3 months after any treatment adjustment, and annually, for an average of 5½ years.  All cardiovascular events during the study (i.e. death, heart attack, angina pectoris, stroke, arterial blockage) were recorded. 

Analyses showed that patients who took at least one blood pressure-lowering medication at bedtime had a significantly lower average sleep-time blood pressure, and a greater proportion of them demonstrated control of their 48-hour blood pressure results (56% vs. 45% of patients who took all their meds on waking up).  Their risk for any cardiovascular event was significantly reduced to approximately 1/3 that of the ‘morning meds’ group).  Bedtime dosing had a similar significant reduction in risk (almost ¼) for a composite outcome of cardiac death, heart attack, and stroke.  And each 5-mm Hg decrease in average night-time systolic blood pressure was associated with a 14% reduction in the risk for a cardiovascular event.

It seems clear that taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events.  But this study was done in chronic kidney disease patients; do the results apply to all antihypertensives?  That must be studied, now.  In the meantime, you can ask your doctor if it would be advisable to take one (or more) of your BP meds at bedtime, to improve your chances of avoiding a ‘cardiovascular event).