HYPERTENSION

SOME EXPERIENCE GAINED, PRACTICAL MEDICAL ADVICE

WHEN IS THE BEST TIME TO TAKE YOUR BLOOD PRESSURE MEDICATION?

We all know what high blood pressure (BP) is. We also know that we must take blood pressure medications to control our blood pressure, in order to prevent high blood pressure related complications in the future. But many really don’t know when the right time is to take the medication for the best effect. 

Hypertension could be defined as resting blood pressure readings above normal.  Normal BP levels have been recently lowered by health care experts and by the American Heart Association.

If sustained resting systolic BP reading (top number) is more than 120 mm Hg, and if sustained the diastolic BP reading (bottom number) is more than 80 mm Hg, it is considered the beginning of hypertension. Systolic BP represents the pressure within the arterial wall, when the heart pumps the blood, and diastolic BP represents the pressure when the heart rests. Random BP readings could fluctuate and is not good metrics to decide about hypertension. Hypertension decision should be made according to sustained and resting BP reading levels, and it is graded as mild, moderate and severe hypertension.

There are two types of hypertension: 

1. Essential (or primary) hypertension, which is the most commonly encountered type of hypertension. Its exact cause is still unknown 

2. Secondary hypertension which is rare and mostly is due to chronic kidney diseases. 

Mild hypertension initially should be treated with la ow sodium diet, exercise, weight loss and quitting smoking. If BP readings do not return to normal levels, then proper medication should be given by your doctor. People usually neglect the treatment of mild hypertension. This is a big mistake. Studies have shown that even a small rise in BP significantly increases the future risk of arteriosclerotic heart diseases, heart failure and strokes. Other major risk factors for heart diseases are obesity, type 2 diabetes and high cholesterol levels. Heart diseases are still leading cause of preventable death in the world. 

I, as a doctor, have been taking BP medications for years. I always wondered, what is the best time to take this medication? 

I know that circadian rhythm can influence the pharmaco-kinetics of many BP medications. But if our doctor doesn’t tell us about this, we tend to develop our own routine of taking medications in the mornings.

Our BP is regulated by the kidneys related “enin–angiotensin–aldosterone” hormonal system. The peak activity of this hormonal system is greatest during sleep. Therefore, it is better and makes more sense to take BP medication before bedtime.

A very interesting clinical study addressing this issue comes from Spain (Hermida RC et al. Eur Heart J. 2019). Investigators in this study randomized more than 19.000 hypertensive patients. Half of them took take their medication in the morning, and the other half took it before bedtime. These cases were closely followed for six years. Study results showed that daytime BP measurements were significantly lower in the group who took their medication at the bedtime. Furthermore, there was almost a 50% reduction in the incidence of cardiac deaths, heart attacks, heart failure and stroke rates in the night group patients, compared to the morning group patients.

This important study provides very strong clinical evidence that the best time to take BP medications should always be at bedtime for maximal effects.