Taking blood pressure meds at night

[Vince]

One reason blood-pressure medications are more effective when taken before bed: They prevent the release of chemicals synthesized during the sleep span that raise blood pressure to abnormal levels, said Smolensky, the journal's editor.

After more than five years of follow-up, those who took at least one of their blood-pressure pills at night seemed to reap significant benefits. Sixty-two percent had controlled blood pressure over the 24-hour period, compared to 53% of those who took all their pills in the morning. Moreover, only 34% of this group were "nondippers," vs. 62% of the morning-medications group, the study authors said.

Those who routinely took at least one of their blood-pressure medicines at night experienced only one-third of the cardiovascular events -- including angina, stroke and heart attack -- suffered by those who swallowed all their blood-pressure pills in the morning, the study found.

Taking Blood Pressure Drugs at Bedtime May Boost Effectiveness

What time should you take blood pressure medications? Research shows that before bed at night may be the best time

www.medicinenet.com

 

[BigTex]

Thanks Vince!

I remember my cardiologist telling me it didn't matter since most have a very long half life. But I disagreed and show my my records taking BP meds in the morning or at night. Part of why he got fired. So I will add to your post.

Ramón C Hermida, Juan J Crespo, Manuel Domínguez-Sardiña, Alfonso Otero, Ana Moyá, María T Ríos, Elvira Sineiro, María C Castiñeira, Pedro A Callejas, Lorenzo Pousa, José L Salgado, Carmen Durán, Juan J Sánchez, José R Fernández, Artemio Mojón, Diana E Ayala, for the Hygia Project Investigators, Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial, European Heart Journal, Volume 41, Issue 48, 21 December 2020, Pages 4565–4576, Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial

Abstract​

Aims
The Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction.

Methods and results
In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio—adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event—of the primary CVD outcome [0.55 (95% CI 0.50–0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34–0.56)], myocardial infarction [0.66 (0.52–0.84)], coronary revascularization [0.60 (0.47–0.75)], heart failure [0.58 (0.49–0.70)], and stroke [0.51 (0.41–0.63)].

Conclusion
Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events.

 

[Fortunate]

I have looked at this, too. The study from Spain gives a compelling reason to take meds at night, but multiple classes of antihypertensives were included, so it may be hard to generalize the recommendations to all drugs if some specific ones were driving the data.

That said, I take mine at night. No reason not to in light of what we know.

 

[Biobro]

Good to keep in mind that some blood pressure meds, can cause insomnia/sleep issues/inhibit REM sleep, if taken before bed. Example: Beta blockers and alpha blockers are one off them.
But usually peoples like to use ARBs, because of better side effect profile.

 

[BigTex]

Yep. To think my cardiologist has me taking beta blockers in the morning and in the evening. My problem is I am good with morning doses but some times forget the evening dose. I also think the half-life of the drug should be considered.

 

[Fortunate]

Some, but not all report fatigue with beta blockers. I take mine at night. I think I sleep deeper and probably have less daytime fatigue.

I was previously on propranolol, which was very fatiguing at the doses I was taking. Now on Bystolic at night time. I still think it causes a little daytime fatigue, but not as much as propranolol, and not as much as if I take it in the AM.

My two cents...

 

[Biobro]

Some, but not all report fatigue with beta blockers. I take mine at night. I think I sleep deeper and probably have less daytime fatigue.

I was previously on propranolol, which was very fatiguing at the doses I was taking. Now on Bystolic at night time. I still think it causes a little daytime fatigue, but not as much as propranolol, and not as much as if I take it in the AM.

My two cents...

I should note that, nebivolol would be exeption, it doesnt fuck up your sleep parameters, inhibit melatonin etc, as long as you dont dose it too high that it loses its selectivity or crosses blood brain barrier too much. I take it 2.5mg daily.

1:
”A trial investigating three β-blockers showed that bisoprolol, but not nebivolol or carvedilol, decreased nocturnal release of melatonin, a phenomenon that may cause sleep disturbances.85 This study also showed that carvedilol slightly decreased quality of life, whereas nebivolol and bisoprolol had no influence, suggesting that different β-blockers exert different clinically relevant effects.”

Nebivolol: impact on cardiac and endothelial function and clinical utility

Endothelial dysfunction is a systemic pathological state of the endothelium characterized by a reduction in the bioavailability of vasodilators, essentially nitric oxide, leading to impaired endothelium-dependent vasodilation, as well as disarrangement ...

www.ncbi.nlm.nih.gov

2:
Conclusion
”Nebivolol was associated with improved sleep, whereas metoprolol was associated with a worsening of sleep characteristics.”

Impact of beta-blockers on sleep in patients with mild hypertension: a randomized trial between nebivolol and metoprolol - Advances in Therapy

Introduction Sleep is an innate and essential part of human life. Various aspects of sleep are negatively affected by beta-blockers. We compared the impact of two beta-blockers, metoprolol succinate (extended release) and nebivolol, on sleep quality in patients with stage 1 hypertension. Methods...

link.springer.com

3:
”As a further feature, it was shown that Nebivolol does not decrease nocturnal melatonin release”

Individual beta-blockers for individual patients

Your access to the latest cardiovascular news, science, tools and resources.

www.escardio.org

 

[Runnerman]

I take Valsartan at night, simply because I have to take synthroid in the morning and the pharmacist recommend splitting them that way. It’s worked ok but my BP is always better in the morning vs. the evening when it’s almost time for my next dose.

 

[Seth]

I recently started taking blood pressure medication. The instructions say to take it in the morning, but I've wondered about this. I might try taking it at night to see what effect it has.

 

[Biobro]

Abnormal blood pressure levels while sleeping increase risk of heart disease, stroke

Research Highlights: Nighttime blood pressure levels that are higher than daytime levels, as well as a pattern of blood pressure rising at night (rather than decreasing slightly), were associated with higher risk of cardiovascular disease and heart...

newsroom.heart.org

On the other hand, too low BP at sleeping isnt good either.

• Even when blood pressure is well controlled during the day, patients who experienced extreme dips in their blood pressure while asleep had a significantly greater risk of stroke compared to those who had normal blood pressure while sleeping.