Taking blood pressure medicine before bed may lower stroke, heart attack risk

It might be worth taking your blood pressure medicine before bedtime, instead of first thing in the morning, a new study suggests.

The study, published Tuesday in the peer-reviewed European Heart Journal, found that taking blood pressure-lowering medications “at bedtime, as opposed to upon waking” may stabilize blood pressure at night and throughout the day, reducing the chance of heart attack, stroke and death.

The trial analyzed data from 19,084 people – 10,614 men and 8,470 women – with high blood pressure. They were between the ages of 46 and 74.

The data was collected in the Hygia Chronotherapy Trial, for an average of six years, which was conducted in 40 primary care centers across northern Spain. Each individual’s blood pressure was monitored annually for 48 hours.

Half were assigned to take their hypertension medications at bedtime, while the other half took theirs in the morning. The medications taken include ramipril, sold as Altace, valsartan, sold as Diovan, and amlodipine, sold as Norvasc.

Those who took their medicine at night “showed significantly lower” rates of issues resulting from high blood pressure.

The rate of heart attacks reduced by 66%, heart failure by 58%, strokes by 51% and death from cardiovascular disease by 44%. The data was adjusted for characteristics such as age, sex, cholesterol levels and other diseases.

The reasons for this, according to some experts, is that taking blood pressure medication at bedtime reduces blood pressure levels during sleeping hours, when most heart attacks and cardiovascular events occur.

Dr. Stephen Kopecky, a cardiologist at Mayo Clinic with a focus on cardiovascular disease prevention, told USA TODAY that it is vital for blood pressure to dip at night to help the heart stay relatively healthy. He is not associated with the study.

”At night, we do a lot of things to rest and regenerate our body,” he said. “Our heart beats 100,000 times a day, and little bits of rest where the heart can rest is very beneficial for it.”

Typically, a person’s blood pressure lowers on its own while sleeping and rises a few hours before waking due to a rush of hormones such as adrenaline and noradrenaline being released. Blood pressure for individuals with hypertension tends to not go down.

”We’re prone to having heart attacks as our body starts to wake up,” he said.

We wake up and we know that we have to have our A-game ready, get the adrenaline flowing, activate our fight-or-flight responses,” said Kopecky. “As you carry that forward, that affects us differently.”

There are no scientific reasons why clinicians tend to advise people to take blood pressure medications in the morning, he said. One factor may be that blood pressure medication is usually taken with a water pill, which reduces fluid and sodium in the body.

Another is that people make it a part of their morning routine.

Kopecky emphasized that lifestyle is far more important than medication in maintaining blood pressure levels.

”We’ve shown over and over and over again that taking the pill doesn’t negate or reverse an unhealthy lifestyle,” he said. “Low-salt diet, regular exercise: Those are incredibly useful to lowering blood pressure.”

The study only took into account Caucasian Spanish people, but Kopecky said that Americans have similar lifestyles. It also didn’t include “people that didn’t have normal daytime routines,” such as people who worked variable shifts like nurses and service employees.

Read more at USAToday.com