Switching your pill routine to bedtime could reduce your risk of
heart disease, death
by Rachel Nania, AARP,
Updated November 7, 2019
En español | Taking blood pressure
medication at night, instead of in the morning, could significantly lower your
risk for heart-related disease and death, a new report suggests.
Researchers studied more than 19,000 adults
with high blood pressure over an average of more than six years and found that
those who took medication at bedtime to lower their pressure cut their risk of
suffering — or dying — from a heart attack, stroke or other cardiovascular event by
nearly half, compared with those who took their blood pressure pills in the
morning.
John Osborne, a cardiologist in Dallas and a
volunteer expert for the American Heart Association, calls the findings
“practice-changing.”
"It's a no-cost, zero-risk,
zero-side-effect intervention that could be done tomorrow in every clinic,”
said Osborne, who is not affiliated with the study, published this week in
the European Heart Journal.
“Just changing to evening dosing could translate to substantial reductions
across the whole realm of cardiovascular events.”
Blood pressure has a daily pattern, Osborne
explained. It normally dips at night and rises in the morning. Then, by the
afternoon, it starts to go down again. This natural rhythm helps to explain why
taking medicine to lower blood pressure may work best when done at night.
"It better targets the morning rise in
blood pressure,” Osborne said. Whereas, “if you take your blood pressure
medicine in the morning, it may already be after the peak, and then the peak
concentration of the drug is hitting a few hours later, well after the peak of
blood pressure.”
Study participants who took all of their blood
pressure pills at night lowered their risk for heart attack by 34 percent,
their risk for stroke by 49 percent and their risk for heart failure by 42
percent, compared with those who took their medicine in the morning, the study
found. Overall, the risk of death from heart or blood vessel problems was cut
by more than 50 percent for the people who took their pills at night.
Allen Taylor, chairman of the department of
cardiology at MedStar Heart and Vascular Institute and professor of medicine at
Georgetown University Medical Center, said the study “is almost too good to be
true in terms of the size of the benefit.” He wants to see further confirmation
before switching all of his patients’ medication schedules from morning to
evening — especially if that change makes them forget to take their blood
pressure pills altogether.
"What we always want to do is make sure
people can take their medicines as conveniently as possible, and if nighttime
is more convenient, I certainly wouldn't hesitate,” said Taylor, who also has
no affiliation with the published report.
The study's population — white men and women
from northern Spain — is one of its biggest limitations. Although 75 million
adults (1 out of every 3) in the U.S. have high blood pressure, black men and women are
disproportionately affected. More than 40 percent of non-Hispanic African
Americans have high blood pressure, and in many cases it develops earlier in
life and is more severe, according to the American Heart Association.
Osborne recommends that the study be repeated
using a more diverse population, but said this report and others before it that
had similar results don't show “any evidence of harm” that would likely be
race-, gender- or ethnicity-specific.
"We're seeing substantial reductions of
cardiovascular events without adding any other drugs — just by changing the
timing,” Osborne said. “And when you look at any adverse events or side effects
or downsides to this approach, there really weren't any.”
If you're already taking your blood pressure
pills at night, Taylor said there's no reason to stop. And if you decide to
switch from the morning to the evening? “Like all things, talk to your doctor
and let him know what you're doing,” he said.
High blood pressure is one of the leading
causes of heart disease, stroke, kidney disease and
death in the U.S., the Centers for Disease Control and Prevention reports.
Editor’s note: This story was updated to note
that participants who took all of their blood pressure pills at night
lowered their risk for heart attack by 34 percent.
https://www.aarp.org/health/conditions-treatments/info-2019/blood-pressure-medication-bedtime.html
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