When is the best time to take your blood pressure medication?

23 October 2019

A major study has revealed that taking blood pressure medication at bedtime rather than on waking halves the risk of events such as heart attack and stroke.

It's a simple tip that could save lives, researchers of the study say in the European Heart Journal. 

There is mounting evidence that many different drugs, including heart pills, might work better when taken at specific times of the day and experts believe our body's biological 'clock' or natural 24-hour rhythm alters our response to the medication.

This latest trial is the largest so far to look at the phenomenon with high blood pressure pills, and included more than 19,000 people on these medications.

In the Spanish study:

• The patients were put into two groups at random - one group took the pills in the morning and the other group took them at bedtime
• Researchers monitored what happened to the patients over the next five or more years
• Patients who took their medication in the evening had nearly half the risk of dying from - or having - a heart attack, stroke or heart failure

The research suggests taking medication in the evening helps keep night-time blood pressure in check, in patients diagnosed with high blood pressure (which doctors call hypertension).

Patients in the study who took 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 each morning.

Lead researcher Prof Ramon Hermida, from the University of Vigo, said doctors might want to consider recommending it to patients: "It's totally cost-free. It might save a lot of lives.

"Current guidelines on the treatment of hypertension do not recommend any preferred treatment time. Morning ingestion has been the most common recommendation by physicians based on the misleading goal of reducing morning blood pressure levels.

"The results of this study show that 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."

He said more studies in different populations were needed to check that the findings will apply to all patients on different brands of blood pressure tablets.

Paul Leeson, a professor of cardiovascular medicine at Oxford University, said the next step was to unpick why the timing of the medication had such an effect, something that could soon become clear with results from other big studies.

“This study has the potential to transform how we prescribe blood pressure medication,” he said. 

Katharine Jenner, CEO of Blood Pressure UK, says: “This is an interesting an important study, as blood pressure medication is life saving, and it should be as effective as possible.  In the UK nearly half of people that should be on blood pressure medication are not taking it properly. This is an urgent and real problem, as although this study shows the medicines work better if you take them in the evening, they don’t work at all if you don’t take them at all.  If you have high blood pressure, not taking your medication puts you at risk of having a stroke of a heart attack, so if there is anything stopping you, be it side effects or convenience, it is imperative you speak to your healthcare professional.”

People can also take action themselves to lower their blood pressure through lifestyle changes. Here are our top tips to a healthy blood pressure:

• Cut down on salt
• Eat more fruit and vegetables
• Lose weight if you need to
• Exercise more
• Stick to the recommended daily amount of alcohol