Dear Pharmacist,
I take four different medications for blood pressure in the morning. The labels all say, “Take once daily.” Is that the best way to take them? I only ask because I bought a blood pressure monitor and I test myself, and my blood pressure is great all day and rises by nightfall.
--D.F., Hollywood, Florida
Answer: Timing medications is very important, because your body has its own biological clock. At night, melatonin seeps out of your brain to help you fall asleep. The body’s production of growth hormones, antioxidants and neurotransmitters is also ramped up at night. In the morning, your body clock releases cortisol and other ‘stress’ hormones which gently raise blood pressure as you wake up.
I think it’s sensible to take some of your blood pressure meds in the morning and some in the evening. I base my recommendation on research that found some people experience a rise in blood pressure while sleeping, rather than a dip. This dip in blood pressure gives your arteries a little vacation. In healthy people, blood pressure naturally dips about 10 to 20 percent while sleeping. You want to be a dipper because it reduces the overall risk of cardiovascular complications. But as I said, some people don’t dip at night; this phenomena affects at least 10 percent of hypertensive patients, but risk is greater if you have kidney failure to go with that hypertension.
Most people with high blood pressure take multiple meds. There are hundreds available. Among the most common are diuretics (which should always be taken in the morning), ACE inhibitors, beta blockers, calcium channel blockers or ARBs (angiotensin receptor blockers). Now, if you take all of your blood pressure pills in the morning, the effects of some may wear off at about the same time, in the evening. This leaves you more susceptible to higher pressures while you sleep.
Making this one little change, that is, taking one or two of your blood pressure medications at bedtime might help you to experience that dip, which is especially crucial if you’re at high risk for heart attack or stroke. Italian researchers evaluated some people with hypertension and kidney disease. They asked participants to switch one of their drugs from a morning dose to a bedtime dose. In about 60 days, almost all of them (90 percent) experienced an average drop in blood pressure by 7 points, without experiencing any more side effects or spikes in their daytime blood pressure. Not only that, but kidney function improved significantly as well!
A common side effect with blood pressure drugs is orthostatic hypotension so get up very slowly from a sitting or resting position to avoid feeling faint or dizzy. Timing won’t alter your risk for this particular side effect so please be careful. Ask your physician or local pharmacist if spreading your medications apart is right for you.
Did You Know?
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