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Bedtime BP meds may cut heart risk by almost half : large randomised study
Blood pressure medicationmay 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.
‘The same medication ingested at different times of the day
actually has different pharmacological properties, behaving
like totally different medications,’ said the study’s lead
author, Ramón Hermida, director of the Bio-engineering
and Chrono-biology Labs at the University of Vigo in Spain.
NBC News reports Hermida and his research team
randomly selected half of the study participants to take their
blood pressure pills upon waking up in the morning. The
other half made the medication part of their bedtime routine.
The team then tracked the patients for six years, periodically
monitoring their blood pressure levels continuously in
48-hour blocks.
The differences in outcomes were striking: compared with
the group who took their pills in the morning, the night-
timers had a more than 40% lower risk of experiencing a
heart attack, heart failure, stroke or needing procedures to
open clogged coronary arteries. What’s more, their risk of
dying from heart problems during the study period was cut
by 66%. By taking your blood pressure medications before
going to bed, you’re preventing high blood pressure during
sleep, which is a significant risk factor for cardiovascular
disease, Hermida is quoted in the report as saying.
Normally, a person experiences ‘nocturnal dipping’ while
asleep at night. Blood pressure ‘dips’ by about 10 to 20%.
But that doesn’t happen in some people, and others may even
experience an increase in blood pressure during sleep, said Dr
Luke Laffin, a preventive cardiologist at the Cleveland Clinic
who was not involved in the research. ‘It makes sense that
if we give blood pressure medicines at night, we may catch
some of those people who have the non-dipping patterns, or
elevated blood pressures at night,’ said Laffin, ‘and protect
them from more cardiovascular disease.’
The report says previous studies had hinted that better
blood pressure control at night might offer a benefit. ‘This
was the piece that was missing,’ Dr Renato Lopes, a professor
of medicine at Duke University School of Medicine, said.
‘For the first time in a very large, randomised fashion, this
study really gave us impressive results,’ said Lopes, who was
not involved in the research.
The report says while the results are encouraging,
researchers say patients with high blood pressure should
speak with their doctors before making any changes to
their blood pressure medication routines. ‘It is important
to understand that this may not apply to medications that
need to be taken more than once a day, or for blood pressure
medications that are being prescribed for other problems
such as angina,’ Dr Tim Chico, professor of cardiovascular
medicine at the University of Sheffield, said.
And there are other caveats, the report says. The new
research had participants take all of their blood pressure
medications at once, either at night or in the morning, rather
than some in the morning and some at night. But some
cardiologists say many patients may need a more tailored
approach. ‘For most people, a combination of a couple
medicines in the morning and a couple in the evening means
you’re going to do better, eliminate side effects and generally
have better control of your blood pressure over 24 hours,’
Laffin said. And people may not want to take certain kinds
of blood pressure medications at night, such as diuretics,
because they increase urination.
The report says the study included only white participants,
so it’s unclear whether the apparent benefits would be as
effective for African Americans, who have consistently higher
uncontrolled blood pressure and heart disease death rates.
The findings also may not apply to people who are awake all
night, such as shift workers.
Meanwhile, simply making sure to take your blood
pressure medications overall has been shown to reduce the
risk of heart attack and stroke significantly. Anyone with a
measurement over 130/80 mmHg is considered to have high
blood pressure, according to guidelines from the American
Heart Association and the American College of Cardiology.
The time of day a person measures his or her blood
pressure may also be key. Readings tend to be higher first
thing in the morning, so many doctors recommend those
keeping track of blood pressure at home take measurements
once in the morning, and once in the evening.
continued on page 372…