The Best Time to Take Blood Pressure Medication

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Taking medication for hypertension before bedtime will not only improve nighttime blood pressure control but also reduce the risk of developing diabetes, suggests a study published in the February 2016 issue of Diabetologia.

Since diabetes is a prime concern for people with high blood pressure, any steps that could cut your risk are worth a closer look.

Blood pressure normally peaks at midday and drops at night. But that nighttime dip doesn’t occur in some people with high blood pressure. And research indicates that having elevated blood pres-sure while you sleep—called nondipping blood pressure—significantly raises your odds of developing diabetes. It’s also a risk factor for stroke, heart attack and kidney disease.

Past research has suggested that taking blood pressure medications at night is associated with better blood pressure control and a reduced risk of heart attack, stroke, or heart failure, among nondippers.

To find out whether taking antihypertensive drugs before bed also reduces diabetes risk, Spanish researchers recruited 2,012 men and women (average age, 53) to participate in a six-year clinical trial. All subjects had high blood pressure, but not diabetes, at the outset. Half the subjects took all their blood pressure medication when they awoke in the morning, and the others took at least one drug at bedtime and the rest in the morning.

At the study’s end, people who took all their drugs at night were 57 percent less likely to have developed diabetes than those who dosed in the morning.

In this study, the drugs that provided the most protection against diabetes when taken in the evening were angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors. The one beta-blocker included in the clinical trial, nebivolol (Bystolic), was about equally effective. However, nighttime dosing of calcium channel blockers, alpha blockers, and diuretics didn’t show similar benefits.

An earlier study by the same authors found that taking antihypertensive drugs at bedtime guards against heart disease, too. “But,” says James L. Weiss, M.D., professor of cardiology at Johns Hopkins University School of Medicine in Baltimore, “using a diuretic medication at night might be unwise for some people since frequent bathroom trips could disturb your sleep. Otherwise, this strategy may make sense for patients at high risk for diabetes.” The American Diabetes Association agrees, recommending that patients take one or all of their blood pressure meds at night.

But before you make any changes to your drug-taking regimen, clear it with your doctor first. He or she may have you taking your blood pressure medication in the morning for good reason, such as preventing too-low blood pressure that may cause a fall if you get out of bed during the night.

If your doctor OKs nighttime doses, but you find it difficult to get into the evening habit, consider going back to taking your meds in the morning. All in all, the best time of day to take your blood pressure meds is when you know you’ll remember to take them.