Does it Matter when is Best Time to Take Blood Pressure Medication?

New research suggests that taking your blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease. Timing of medication is important because blood pressure follows a daily rhythm. It rises higher during the day and falls at night when we sleep.

Blood pressure medication may confer a larger benefit if taken at night, rather than in the morning. A 'robust' Spanish study of more than 19 000 patients found that taking the medication so that it works overnight cuts the risk of heart-related death and disease nearly in half.

Contrary to what doctors have said for years, some researchers now say it doesn’t matter what time of day someone takes their blood pressure medication. Researchers followed more than 21,000 people with high blood pressure over five years. Subjects were randomly assigned to take their blood pressure drugs in the morning or evening. Researchers then looked for hospitalization for heart attack, stroke, or death from cardiovascular disease. Over a five-year median, 3.4 % of those taking medication at night were hospitalized for heart attack, stroke, or died from cardiovascular disease. That compared to 3.7% who took their medication in the morning. Researchers said the results contradict previous research pointing to a large benefit when taking medication only at night. Thomas MacDonald, a professor at the University of Dundee in Scotland who was one of the researchers on the project, said the study “was one of the largest cardiovascular studies ever conducted and provides a definitive answer on the question of whether blood pressure-lowering medications should be taken in the morning or evening,” “The trial clearly found that heart attack, stroke, and vascular death occurred to a similar degree, regardless of the time of administration,” MacDonald said in a statement. “People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them and minimizes any undesirable effects.”

What other experts have to say

Dr. Amanda Adkins

She is a primary care physician with North Bay Health in Fairfield, California, told Healthline as long as people take their medication every day, then the time of day shouldn’t really matter. “There are some medications for blood pressure that were recommended to take at night such as beta blockers like metoprolol as there was study done that thought risk for heart attack was higher in the morning,” Adkins said. “Therefore, taking medication at night should possibly decrease that risk.” “While this may be true, most medications are taken once a day and last in one’s system for 24 hours,” Adkins noted. “There are other medications like diuretics or water pills that are recommended to take during the day because one may need to urinate more often.” “Because most medications last 24 hours the time of day may not be as important,” she added. “I know compliance is a big issue for patients. So, as long as they take the medication every day they will see benefits.”

Dr. Nicole Harkin

He is a cardiologist and founder of Whole Heart Cardiology in San Francisco, told Healthline she goes by a pretty simple premise when telling patients when to take their blood pressure drugs. “I typically recommend that most of my patients take their blood pressure medications when they are most likely to remember to take them,” Harkin said. “There is some evidence, however, that it may be better to take them at night. This is based on research that has shown that individuals with hypertension may not drop their blood pressure at night, which is what occurs in individuals without hypertension. Taking blood pressure medicines at night may help simulate this normal blood pressure dipping pattern.”

Dr. Stephen Pickett

He a cardiologist at Memorial Hermann Memorial City Medical Center in Houston, told Healthline not all blood pressure medications work the same way. “There are dozens of blood pressure medications and they are not all the same. They have different durations of action, different mechanisms of lowering blood pressure, and different side effects, which can play a role in the ideal time for taking them,” Pickett said. “Some blood pressure medications, for example, need to be taken 3 to 4 times per day due to their short duration of action. Others have a very long duration of action and can be taken any time of day and their effect will likely not vary,” Pickett said. “Others still, such as diuretics, I generally recommend taking in the morning because the effect of taking them at night can be frustrating.”

Pickett said historically different studies get different results. “There have been a number of studies over the years about the optimal time to take blood pressure medications and they have had varying results,” he explained. “Some studies suggested blood pressure control was better when patients took their once-a-day blood pressure medications in the evening. This was done by 48-hour blood pressure monitors.” “I would recommend talking to your doctor about the best time to take your blood pressure medications because not all medications are the same,” Pickett noted. “For my patients on once-a-day blood pressure medications, I encourage them to find a time of day where they will remember to reliably take their medications. It does no good to ‘take it in the evening’ if they routinely forget to take it. “All else being equal, there are several studies suggesting a small advantage to taking blood pressure medications at night, but it is not enough yet to insist on my patients taking their medications only at night,” he concluded. Harkin noted that maintaining normal blood pressure is important for overall heart health. “Elevated blood pressure is one of the top causes for stroke and heart attack,” she said. “Lifestyle changes are typically our first line of treatment. Some of the most effective lifestyle changes are reducing alcohol intake – no more than one drink a night for women and two for men – eating a DASH (Dietary Approaches to Stop Hypertension) style plant-forward diet low in sodium, including aerobic exercise as well as strength training, and losing weight if above ideal body weight.”