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Better take medication for high blood pressure before going to bed
A new study has shown that antihypertensive drugs work much better if they are not taken in the morning but before bedtime. The pills then offer more protection against heart attacks and strokes.
People with high blood pressure who take their antihypertensive medications at bedtime have better controlled blood pressure and a significantly lower risk of cardiovascular disease than those who take their medications in the morning. This is shown by a new study from Spain. According to the researchers, the results could possibly lead to changes in the prescription of such preparations.
Study with more than 19,000 participants
As the European Society of Cardiology (ESC) writes in a statement, a total of 19,084 hypertension patients (10,614 men and 8,470 women) were randomly selected for the current study published in the journal "European Heart Journal" between 2008 and 2018 made to take her hypotensive pills either when you wake up or before you go to bed.
At the start of the study and each subsequent visit to the clinic, the blood pressure of the participants was measured. After each visit to the clinic and at least once a year, outpatient blood pressure monitoring was carried out over a period of 48 hours. This provided information about the average blood pressure during the 48 hours, including how much the blood pressure had dropped while the participants were sleeping.
During a median (average) follow-up of 6.3 years, 1,752 cardiovascular events such as heart attack, stroke, death from cardiovascular disease and heart failure were recorded.
Halving the risk of cardiovascular diseases
It was shown that participants who took their medication before bed had a significantly lower average blood pressure both at night and during the day and had a greater drop in blood pressure at night than those who took their medication after waking up.
In addition, researchers from the University of Vigo (Spain) found that the risk of events like heart attack, stroke, or heart failure was almost halved in those who took their medication before bedtime compared to those who took the pills in the morning ( 45% reduction). The study also found that evening use was associated with a 56% lower risk of death from cardiovascular disease.
In addition to the effect on blood pressure, the team showed that those who took the drug before bed also had better kidney function and cholesterol levels, both important factors in cardiovascular disease. According to the information, the analysis also took into account factors that could influence the results, such as age, gender, type 2 diabetes, kidney disease, smoking and cholesterol levels.
Prof. Ramón Hermida, first author of the study, said the positive effect is due to the "internal clock" or the natural 24-hour rhythm of the body, which changes the response to the drug. Earlier studies had also shown that various medications work better at certain times of the day. This finding is also taken into account in drug delivery. Experts speak of "chronotherapy" in this context.
Hypertension at night is more dangerous
Prof. Ramón Hermida, first author of the study, said: “Current guidelines for the treatment of high blood pressure do not mention or recommend a preferred treatment time. Because of the misleading goal of lowering blood pressure in the morning, taking it in the morning was the most common recommendation from doctors. ”However, a previous study by a team led by Prof. Ramón Hermida, also published in the“ European Heart Journal ”, found that high blood pressure in the Night significantly more dangerous and associated with an increased risk of cardiovascular events.
“The results of this study show that patients who routinely take their antihypertensive medication before bedtime, as opposed to those who do when they wake up, have more controlled blood pressure and, above all, a significantly lower risk of death or illness due to Heart and circulatory problems, ”said the study author.
Do not change medication intake yourself
"This study has the potential to change the way we prescribe blood pressure medication," said Paul Leeson, professor of cardiovascular medicine at Oxford University, in a report by The Guardian. The scientist, who was not involved in the study, said the next step was to find out why the timing of the medication had such an effect.
In a BBC article, Vanessa Smith of the British Heart Foundation pointed out that the current study "confirms previous knowledge in this area," but more research is needed "to really prove that taking blood pressure medication is more beneficial for cardiovascular health at night. "
In addition, she warned of the arbitrary change in medication intake: "If you are currently taking blood pressure medication, it is important that you check with your family doctor or pharmacist before changing the intake time. There can be certain reasons why your doctor has prescribed morning or evening medication. ”
Finally, the BBC report points out that lifestyle factors also affect blood pressure. Therefore, avoid drinking too much alcohol, smoking, being overweight, not exercising enough, and eating too much salt. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- European Society of Cardiology (ESC): Bed time is the best time to take blood pressure medication, (accessed: October 23, 2019), European Society of Cardiology (ESC)
- European Heart Journal: Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial, (accessed: October 23, 2019), European Heart Journal
- European Heart Journal: Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for prevention, (accessed: October 23, 2019), European Heart Journal