Blood pressure medication much better at bedtime

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Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. It usually refers to the   arterial pressure of the systemic circulation. During each heartbeat, BP varies between a maximum (systolic) and a minimum (diastolic) pressure. It is measured on the inside of an elbow at the brachial artery, which is the upper arm’s major blood vessel that carries blood away from the heart. Normal blood pressure is 120/80 mm/Hg.

Hypertension (HTN) or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated meaning that the heart is having to work harder than it should to pump the blood around the body. Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure.

Medications
Several classes of medications, collectively referred to as antihypertensive drugs, are currently available for treating hypertension. Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of  heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

Taking blood pressure medication at bedtime is better-a study
In a study, Dr Ramón Hermida and colleagues from the University of Vigo, Spain found that patients who took at least one blood- pressure lowering medication at bedtime had better control of their blood pressure and were less likely to experience strokes and heart problems than those who took their medications first thing in the morning. The results suggest that with little extra effort and at no extra cost, patients could significantly reduce their risk of heart attack, stroke and other heart conditions.

According to the World Health Organization (WHO), “Hypertension is common around the world, mainly because people are living longer and due to factors such as obesity, changed life styles etc.However, while the treatment of the condition has been shown to prevent cardiovascular diseases and to extend and enhance life, we don’t seem to be managing high blood pressure as well as we could”.

The researchers set selected a group of 661 patients with chronic kidney disease and high blood pressure. They randomly assigned the patients to one of two groups. In one group the patients took all their prescribed hypertension medications first thing in the morning and in the other group they took at least one of them at bedtime.

They measured the patients’ blood pressure (by asking them to wear...



an ambulatory monitor for 48 hours) at the start of the study, and also 3 months after any change in treatment, or at the least, every year.

After a follow up of more than5 years, the researchers found that :

  • The patients who took at least one blood-pressure lowering medication at bedtime had an adjusted risk for total cardiovascular events two thirds lower than those who took the medicines when they woke up in the morning.
  • There was a similar significant reduction in risk for bedtime dosing for a composite of three events: cardiovascular death, myocardial infarction, and stroke.
  • Also, the patients who took at least one med at bedtime had a significantly lower average sleep-time blood pressure and more of them showed better control of ambulatory blood pressure

Hermida  concluded :

“Our results indicate that cardiovascular event rates in patients with hypertension can be reduced by more than 50% with a zero-cost strategy of administering blood pressure-lowering medications at bedtime rather than in the morning. This study also documents for the first time that sleep-time blood pressure is the most relevant independent marker of cardiovascular risk.”

Hypertension is a common problem in older people, who are on medication, almost, for rest of their life.  I know many people in my family that take blood pressure medication in the morning to meet their daily dose requirement.  The study does not go into, why the patients reduced their risk of heart conditions when they took medicine during bed time as suppose to morning.  But, I think the study prompts you to think that if this simple change in medication time can help your heart condition, it is worth pursuing.  Consult your physician regarding this study and switch to a bed time BP medication.

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