Tip of the Week: BP meds more effective when taken at night

HeartHawk
By HeartHawk Latest Reply 2012-04-08 23:58:00 -0500
Started 2011-11-06 21:33:33 -0600

There has always been a question as to waht is the best time to take BP meds. This new study may answer that question.

http://www.heartconnect.com/news-articles/450...

Anyone have any experience suggesting better BP control based on when you take your meds?

HH


12 replies

redorangedog
redorangedog 2011-11-11 18:09:16 -0600 Report

Redorangedog, My cardiologist said to take Lisinopril for HTN at night. He said it would reset my bio-rhythm. At my am appointments b/p=90/50. Acupuncturist said vitamins in AM, Minerals in PM. Red

HeartHawk
HeartHawk 2011-11-28 23:44:20 -0600 Report

red,

Hmmm, Lisinopril is a great blood pressure drug but I have not seen anything that suggests Lisinopril can "reset" biorhythms. No harm done but it sounds like your doc is pulling your leg in an attempt to get you to comply with the dosing protocol. Let us know if you find info supporting the biorhythm theory! If true, it would certainly be useful.

HH

redorangedog
redorangedog 2011-12-01 16:40:18 -0600 Report

Redorangedog, It is not the drug, it was the time to take the drug that was important. I have not found any scientific basis for his order to take the medication at bedtime either. However, it helps with compliance. Sometimes I forget to take my meds for days at a time even with the days of the month pill container filled. When I remember what the doctor said, it makes me laugh and I am more compliant. He is Chinese and said "it is accent Chinese wisdom." Red

redorangedog
redorangedog 2011-12-02 16:02:59 -0600 Report

Redorangedog, HH, you made me stop and think, thank you. I did not do any research into this topic and took what the doctor told me to do as gospel because I admire his work and reputation. I did not do my homework and check out this order by myself. I am glad you are on your toes, and read my post to the question on time relating dosing and questioned my reply. I started to look for an answer that was supported by clinical trials. I found many studies that were done to support the idea of time being a factor in many medications that are being used to treat a variety of diseases. We are lucky to be in the electronic age. When, if you have a question, the answer is just moments away with google.com. Red

HeartHawk
HeartHawk 2012-04-08 23:58:00 -0500 Report

red,

Yup, the Internet sure makes taking care of yourself a whole lot easier. If you think about, timed dosing makes sense as your body follows cycles.

HH

redorangedog
redorangedog 2011-12-02 15:44:03 -0600 Report

Redorangedog, This is a synopsis of a recent study hailing the benefits of evening B/P medication dosing:

http://www.ncbi.nlm.nih.gov/m/pubmed/20854139/

Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study.

Clinical studies have documented morning-evening, administration-time differences of several different classes of hypertension medications in blood pressure (BP)-lowering efficacy, duration of action, safety profile, and/or effects on the circadian BP pattern. In spite of these published findings, most hypertensive subjects, including those under combination therapy, are instructed by their physicians and pharmacists to ingest all of their BP-lowering medications in the morning. The potential differential reduction of cardiovascular (CVD) morbidity and mortality risk by a bedtime versus upon-awakening treatment schedule has never been evaluated prospectively. The prospective MAPEC study was specifically designed to test the hypothesis that bedtime chronotherapy with ≥1 hypertension medications exerts better BP control and CVD risk reduction than conventional therapy, i.e., all medications ingested in the morning. A total of 2156 hypertensive subjects, 1044 men/1112 women, 55.6 ± 13.6 (mean ± SD) yrs of age, were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h. Physical activity was simultaneously monitored every min by wrist actigraphy to accurately determine the beginning and end of daytime activity and nocturnal sleep. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Despite lack of differences in ambulatory BP between groups at baseline, subjects ingesting medication at bedtime showed at their last available evaluation significantly lower mean sleep-time BP, higher sleep-time relative BP decline, reduced prevalence of non-dipping (34% versus 62%; p < .001), and higher prevalence of controlled ambulatory BP (62% versus 53%; p < .001). After a median follow-up of 5.6 yrs, subjects ingesting ≥1 BP-lowering medications at bedtime exhibited a significantly lower relative risk of total CVD events than those ingesting all medications upon awakening (0.39 [0.29-0.51]; number of events 187 versus 68; p < .001). The difference between the treatment-time groups in the relative risk of major events (including CVD death, myocardial infarction, ischemic stroke, and hemorrhagic stroke) was also highly statistically significant (0.33 [0.19-0.55]; number of events: 55 versus 18; p < .001). The progressive decrease in asleep BP and increase in sleep-time relative BP decline towards a more normal dipping pattern, two novel therapeutic targets requiring proper patient evaluation by ambulatory BP, were best achieved with bedtime therapy, and they were the most significant predictors of event-free survival. Bedtime chronotherapy with ≥1 BP-lowering medications, compared to conventional upon-waking treatment with all medications, more effectively improved BP control, better decreased the prevalence of non-dipping, and, most importantly, significantly reduced CVD morbidity and mortality.

RED

re1ndeer
re1ndeer 2011-11-10 00:14:50 -0600 Report

I don't know if it's better control or not, but, I take two different Bp medications.

They are spaced through out the day. I take Metroprolol, and Losartan.

I take the Metroprolol at breakfast, and again at suppertime. I take the Lorsartan at bedtime.

My Bp readings which I keep track of daily run just about the 115/69 (Sys/Dai - readings), but occasionally fluctuate, sometimes higher, sometimes lower.

HeartHawk
HeartHawk 2011-11-10 23:31:01 -0600 Report

re1ndeer,

Hey, we miss you! Glad to hear from you again and glad to see your BP is well-controlled. Sounds like you are on standard beta-blocker and ARB regimen. Any problems or side-effects?

Excellent that you track your BP (more people on drug regimens should do this)! Do you use an automated BP cuff or do you use a manual cuff and stethoscope to take your BP readings?

HH

re1ndeer
re1ndeer 2011-11-29 07:59:55 -0600 Report

Sorry to get back to you late, Holidays and such. I use an automated Bp Cuff, on the wrist.
So far, no side affects from the BP meds.

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