There are many different high blood pressure medications (antihypertensives) available, each with pros and cons. And the doctor might prescribe more than one type to treat the condition because how well a drug works can depend on age, sex, race, blood pressure level and overall health.

Medication can help to prevent possible long-term health consequences of high blood pressure, such as heart attacks and strokes. Because the various medications are equally effective at lowering blood pressure, it’s often possible to find one that is well tolerated. There is mounting evidence that many different drugs, including high blood pressure medications, might work better when taken at specific times of the day.

This is particularly now that the latest trial on these medications says that taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure. Researchers in Spain had followed more than 19,000 adults with high blood pressure. They found that people who took all their blood pressure medications at night had lower blood pressure round the clock compared to volunteers who took their medication in the morning.

The study results were published on-line October 22 in the European Heart Journal. The investigation — called the Hygia Chronotherapy Trial — ran between 2008 and 2018. It involved about 10,600 men and 8,500 women in northern Spain, aged 18 and older.

Study participants were randomly assigned to take all of their blood pressure pills just once a day, either in the morning or at bedtime. They had been diagnosed with high blood pressure before the study started. They were all tracked for a little over six years on the average. Blood pressure was repeatedly assessed throughout the study. At least once a year, participants also wore a mobile monitor, which logged multiple blood pressure readings over two days.

In the end, the investigators found that those who always took their medications at bed time saw their risk of dying as a result of heart or blood vessel problems reducing by two-thirds, compared with those who always took them in the morning.

The researchers reported that a bedtime drug regimen was also linked to a 44 per cent reduction in heart attack risk; a 40 per cent reduction in the risk for surgery to unblock narrowed arteries (coronary revascularisation); a 42 per cent lower risk for heart failure; and a 49 per cent in stroke risk. Overall, the yearly 48-hour mobile blood pressure readings showed that patients who took their medications at night had “significantly reduced” blood pressure while asleep, compared with their peers who followed a morning medication routine.

Howbeit, Dr Abiodun Adeoye, a consultant cardiologist, University College Hospital (UCH), Ibadan, said all high blood pressure medications are not created equally and as such individuals with hypertension should still talk to their doctor about the best time to take their medications. According to Dr Adeoye, “you cannot take at night anti-hypertensive medication like diuretics. If you do, the patient will not sleep and if you are not sleeping, the blood pressure will not get regulated.”

Current guidelines on the treatment of hypertension do not mention or recommend any preferred treatment time. But for diuretics, morning ingestion has been the most common recommendation to avoid frequent urination disturbing sleep.

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