A new study has revealed that people with high blood pressure who take all their anti-hypertensive medication at one go at bedtime have better-controlled blood pressure and a significantly lower risk of death or illness caused by heart or blood vessel problems as compared to those who take their medication in the morning.

Furthermore, there are no studies showing that treating hypertension in the morning improves the reduction in the risk of cardiovascular disease.

Patients who routinely take their anti-hypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems.

Between 2008 and 2018, 10,614 men and 8,470 women of Caucasian Spanish origin, aged 18 or over, who had been diagnosed with hypertension by means of ambulatory blood pressure monitoring, were recruited to the trial. They had to adhere to a routine of daytime activity and night-time sleep, which means that it is not possible to say if the study findings apply to people working night shifts.

Doctors took the patients’ blood pressure when they joined the study and at each subsequent clinic visit. Ambulatory blood pressure monitoring over a 48-hour period took place after each clinic visit and at least once a year. This gave doctors accurate information on average blood pressures over the 48 hours, including how much blood pressure decreased or ‘dipped’ while the patients were asleep.

Data from ambulatory blood pressure monitoring showed that patients taking their medication at bedtime had significantly lower average blood pressure both at night and during the day, and their blood pressure dipped more at night when compared with patients taking their medication on waking.

A progressive decrease in night-time systolic blood pressure during the follow-up period was the most significant predictor of a reduced risk of cardiovascular disease.

Accordingly, round-the-clock ambulatory blood pressure monitoring should be the recommended way to diagnose true arterial hypertension and to assess the risk of cardiovascular disease.

In addition, decreasing the average systolic blood pressure while asleep and increasing the sleep-time relative decline in blood pressure towards morning.

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