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The time of day you take blood pressure pills can make a big difference

By February 19, 2022Deadline Detroit

Results of a large research study on patients taking blood pressure medication could improve hypertension control and reduce heart disease events.

That’s an unusual impact from just one trial study, but the Hygia Chronotherapy Study published by the European Heart Journal in 2020 did just that. You might want to discuss it with your health provider.

Here’s a summary:

♦ What was looked at: The study was based on observations that some blood pressure medications, including some of the most popular ones, have peak activity at night — so taking those pills at bedtime may have more impact. Therefore, the trial randomized patients on an existing blood pressure regimen of one to three so that some took them all at night and others did so when they awakened.

(Photo: DepositPhotos)

♦ Who was tested and how: Investigators used a network of primary care clinics in Spain and identified 19,084 participants. They were followed at least annually for just over six years. Subjects also wore a 48-hour blood pressure monitor. Researchers kept track of the number who suffered a primary cardiovascular disease event (cardiovascular death, heart attack, stroke, cardiac intervention like bypass surgery or stent, and congestive heart failure). 

♦ What was found: Investigators reported that among the 1,752 participants who experienced a primary outcome, patients taking medication at bedtime had a significantly fewer adverse events.
Cardiac death was lowered by 56%, heart attack by 34% and coronary revascularization like stents by 40%. Heart failure was 42% lower and stroke was 49% lower.

♦ Benefit from night medication: Prior studies had shown that the blood pressure while asleep was the most accurate at predicting future heart events. In the Hygia trial, named for the Green goddess of health, daytime blood pressure was similar in both groups but sleep blood pressure was lower in those taking all their medications at night.

♦ What patients should do: Those taking blood pressure medicine should ask their healthcare practitioner whether switching all medications to nighttime use is reasonable.

For most patients, the goal of blood pressure therapy is not symptom relief, but the hope that future heart events will be avoided. Bedtime dosing for most patients may translate to literally millions of events avoided.

(Graphic: European Heart Journal, Dec. 21, 2020)