By Rachel Nania, AARP, July 2024
Morning, noon or night? Doctors offer advice on determining the right timing for your hypertension pills.
Your doctor wrote you a prescription for blood pressure medication, and you’re wondering: When’s the best time to take it?
There’s been some debate over the answer in recent years. Most notably, a study of more than 19,000 adults published in 2019 in the European Heart Journal found that people with high blood pressure — also referred to as hypertension — who took their medication at bedtime significantly lowered their risk of a heart attack, stroke or other cardiovascular event, compared with those who took their blood pressure pills in the morning. That research was followed up by a large clinical trial, published in The Lancet in 2022, that found there was no real difference in heart attack and stroke risk in people who took their blood pressure medication in the morning versus the evening.
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“The jury is still out,” says Donald Lloyd-Jones, M.D., chair of the Department of Preventive Medicine at the Northwestern University Feinberg School of Medicine. In the meantime, doctors do have some advice on how to approach your blood pressure medication routine.
Why timing hypertension pills may matter
Your blood pressure isn’t static; it changes throughout the day. In many people, it starts to rise in the morning, when “the body’s getting ready for the day, the brain is activated and everything’s kind of gearing up,” Lloyd-Jones says. And most people find it dips at night when they’re sleeping.
However, that’s not always the case for everyone. People with irregular patterns may experience surges late at night or in the early morning hours.
Knowing when your blood pressure is at its highest can help you and your doctor pinpoint the best time to take your medication. You’re going to see the strongest effect from the medicine soon after you take it, explains Kent Brummel, M.D., a cardiologist and clinical assistant professor in the Division of Cardiovascular Medicine at the University of Michigan. Peak effect is usually achieved within a few hours of swallowing your pill, according to the Cleveland Clinic.
While many blood pressure medications are long-lasting, some are shorter-acting and lose their effectiveness as time wears on, Lloyd-Jones says. “If you are taking [your medication] in the morning, and you’re somebody who has a surge of blood pressure [earlier] the next morning, you may not be as protected if you’re taking a shorter-acting blood pressure medication,” he says. “So I think it’s important to establish what an individual patient’s blood pressure pattern is and then react accordingly, so that we really are covering them through the full 24 hours of their day.”
Figuring out your blood pressure pattern
Talk to your doctor about the types of medications you take to lower your blood pressure and whether you might benefit from adjusting the time of day you take them, advises Lloyd-Jones, based on your blood pressure’s pattern.
To figure out this pattern, you can take your own blood pressure readings throughout the day. There’s also a special blood pressure cuff your doctor can prescribe — this is called “ambulatory blood pressure monitoring” — that will automatically measure your blood pressure over a 24-hour period.
A few other things to consider: If you feel the effects of a drop in blood pressure after taking your medication — say you become dizzy or lightheaded — tell your doctor, as they may want to factor this into your medication timing, Brummel says. The same goes if you take a diuretic, sometimes called a water pill, that keeps you running to the bathroom to urinate. This side effect may be less desirable overnight, which is why doctors sometimes recommend taking diuretics in the morning or, if you take them twice daily, at least six hours before bedtime, according to the Mayo Clinic.
Consistency is key when taking BP meds
Research into the topic of medication timing is ongoing, and Brummel says recommendations could be updated in the future. But for now, what’s most important, doctors say, is to pick a time of day when you’re most likely to remember to take your pills — whether that’s morning, noon or night — and stick with it.
“It’s definitely best to just take your medicines whenever you will remember. That’s certainly beneficial more so than timing,” Brummel says.
“Adherence is a crucial part of whether medications are going to work,” says Lloyd-Jones. “If you’re not taking it, it’s never going to work.”
High blood pressure, or hypertension, is a major risk factor for heart disease and stroke — two of the country’s leading killers. In 2021, there were 691,095 deaths in the United States attributed to high blood pressure, according to the Centers for Disease Control and Prevention.
Medication is one way to help lower blood pressure. Lifestyle changes, such as getting regular exercise and avoiding smoking, can also help.
How Blood Pressure Medications Work
There are various types of blood pressure medications, and they work in different ways. Common ones include:
Diuretics: Help the body get rid of extra salt and water, which can increase blood pressure
Beta-blockers: Lower the heart rate, which can lower blood pressure
ACE inhibitors: Help the body produce less angiotensin, a chemical that causes the arteries to narrow
Angiotensin II receptor blockers (ARBs): Block the effects of angiotensin
Calcium channel blockers: Relax and open narrowed blood vessels, reduce heart rate, which can lower blood pressure
Alpha blockers: Reduce resistance in the arteries
Central alpha-2 receptor agonists: Block brain signals that can increase heart rate and narrow blood vessels
Combined alpha and beta-blockers: Can be prescribed for blood pressure control in people at risk of heart failure
Vasodilators: Relax the blood vessel walls
Source: American Heart Association
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