Taking BP Medications at Night May lower Stroke and Heart Attack Risk

By Peter Laird, MD

A recent study published in JASN reveals significantly reduced rates of cardiovascular outcomes when patients take their anti-hypertensive medications at bedtime. Understanding that the the early morning to mid morning hours have the highest risk of heart attack and stroke. Many believe that the circadian rhyths and endocrine realeases of cortisol and other hormones may contribute to acute cardiovascular events. This latest study explored whether taking anti-hypertensive medications at night would have any influence on these events:

Bedtime Dosing of Antihpertensive Medications Reduces Cardiovascular Risk in CKD

After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0.31; 95% CI 0.21 to 0.46; P < 0.001).

Bedtime dosing demonstrated a similar significant reduction in risk for a composite outcome of cardiovascular death, myocardial infarction, and stroke (adjusted HR 0.28; 95% CI 0.13 to 0.61; P < 0.001). Furthermore, patients on bedtime treatment had a significantly lower mean sleep-time BP and a greater proportion demonstrated control of their ambulatory BP (56% versus 45%, P = 0.003). Each 5-mmHg decrease in mean sleep-time systolic BP was associated with a 14% reduction in the risk for cardiovascular events during follow-up (P < 0.001).

In conclusion, among patients with CKD and hypertension, taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events.

 

Comments

[MooseMom]

My neph's nurse once told me that cholesterol meds seemed to work better when taken in the evening, so I've been doing that for some years now, but no one has ever discussed the timing of BP meds with me. I take three, so I will follow this advice and take at least one at night. Thank you for posting this. I'll start my new schedule tomorrow night!

[Peter Laird, MD]

Dear Moosemom, that should ordinarily be fine, but as in all things medical, double check with your doctor on which meds you are on that you should take during the day or at night. If it doesn't matter what time you take it, then according to this study, it appears that night time is the best. It makes sense to have the highest levels of meds for the morning when the normal circadian rhythms place the body under the most stress instead of having them at their lowest levels.

Once again, I would recommend you check with your health care team.

God bless,

Peter

[MooseMom]

Oh, I'll do that! But I find it rather odd that no one has ever discussed this issue with me. When my neph prescribed binders, he never said anything about timing; I had to read the patient info pamphlet to discover that I shouldn't take any other meds either one hour before or 3 hours after taking the binders. Would have been nice to have been warned. Not everyone reads those pamphlets.