Take antihypertensive drugs at bedtime for maximum benefit, say researchers

Blood-pressure-lowering drugs may be more effective when taken at night, according to new research.

The body's circadian rhythm influences blood pressure and the effects of antihypertensive drugs. | GETTY IMAGES

Taking antihypertensive medication at bedtime rather than on waking is associated with better blood-pressure control and a reduced risk of cardiovascular events, a study published in the European Heart Journal suggests.

Spanish researchers conducted an open-label controlled trial in 19,084 white patients with hypertension, who were randomised to take their daily dose of blood-pressure-lowering medication at bedtime or on waking. 

During a median of 6.3 years of follow-up, 1752 participants experienced the primary outcome of cardiovascular death, myocardial infarction, coronary revascularisation, heart failure, or stroke.

Participants who took their medication at bedtime had significantly lower rates of the primary outcome than those who took their medication on waking (adjusted hazard ratio [HR] 0.55, 95% CI 0.50–0.61; p < 0.001). Rates were lower in the bedtime dosing group for each individual endpoint (p < 0.001 for all), ie cardiovascular death (HR 0.44, 95% CI 0.34–0.56), myocardial infarction (HR 0.66, 95% CI 0.52–0.84), coronary revascularisation (HR 0.60, 95% CI 0.47–0.75), heart failure (HR 0.58, 95% CI 0.49–0.70), and stroke (HR 0.51, 95% CI 0.41–0.63).

The bedtime regimen was also associated with better lipid profiles and better sleeping blood-pressure profile.

Lead researcher Professor Ramon Hermida, from the University of Vigo, said doctors might want to consider recommending bedtime dosing to patients: "It's totally cost-free. It might save a lot of lives.

"Current guidelines on the treatment of hypertension do not recommend any preferred treatment time. Morning ingestion has been the most common recommendation by physicians based on the misleading goal of reducing morning blood pressure levels.

"The results of this study show that patients who routinely take their anti-hypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems."

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