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Fact Checked

Blood Pressure Medications: Does Timing Matter?

Blood pressure is one of the easiest and most convenient ways to assess a person’s health. Millions of individuals get their blood pressure measured daily by their physicians, nurses, pharmacists, or even by themselves. 

A “good” blood pressure is defined as a systolic value of less than 120 millimeters of mercury (mmHg) combined with a diastolic value of less than 80 mmHg. This is often represented by a number like 120/80 mmHg.

What Do Your Blood Pressure Numbers Mean?

Simply, blood pressure is the pressure of your blood pushing against the walls of your arteries; these are vessels that carry blood away from your heart and towards your body. The “systolic” value is the pressure in your arteries when your heart beats. The “diastolic” value is the pressure in your arteries between heartbeats.

The higher your blood pressure, the higher the risk of developing heart disease, heart attack, or stroke. 

Normally, individuals get diagnosed with high blood pressure, or hypertension, if their blood pressure is above 130/80 mmHg.

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The Burden of High Blood Pressure

About 45% of all U.S. adults are diagnosed with hypertension. Out of these individuals, only about a quarter have their blood pressure under control. This leaves millions of people who are  not properly controlled. 

Controlling your blood pressure is important for your health. It is one of the key recommendations from the American Heart Association to maintain a heart healthy lifestyle: by:

  • Exercise 
  • Eat healthy 
  • Don’t smoke 
  • Limit alcohol 
  • Control your blood pressure 
  • Control your blood sugars 
  • Control your cholesterol 
  • If you are on medications, be adherent to your medications.

These recommendations also affect one another; if you exercise and eat healthy, it should be easier to maintain better blood pressure. 

Unfortunately, tight blood pressure control can be challenging, which is why three-quarters of Americans are still unable to maintain a healthy blood pressure.

Time Your Medications Right

There are several different medications that you can take to manage high blood pressure. When an individual develops hypertension, adherence (taking medicine as prescribed) to their medications is an important weapon against worsening blood pressure. 

Sticking to a treatment plan will surely make your physician and pharmacist happy. However, it is also important to take medications at a time that works for you. It is easier to be adherent to a therapy regimen if medications can be taken consistently and conveniently. 

Furthermore, taking your blood pressure medications the right way does more than making everyone happy. It can also help further reduce heart disease by maintaining a better blood pressure level. 

Evidence shows that taking blood pressure medications at bedtime instead of in the morning seems more beneficial for overall blood pressure control. 

A recent study found that blood pressure while sleeping seems to be a better predictor of heart disease than awake blood pressure.

Another article that reviewed several studies found that adding some blood pressure medications before bedtime helps control blood pressure for the entire day.

NOTE: please consult your healthcare provider first before changing the timing of any of your medication. 

Considerations for Bedtime Medications

Blood pressure medications are some of the most commonly prescribed medications with four out of the 20 most prescribed medications in the U.S. being used for blood pressure control: 

Not all blood pressure medications are the same. In fact, each of the medications listed above works through a different mechanism to help control blood pressure. For example, hydrochlorothiazide is known as a “water pill”, since it helps the body remove excess fluids, relieving some of the pressure in the vessels. The excess fluid is removed through more frequent urination. Hydrochlorothiazide is an example of a medication that would not ideally be taken at night because it can cause you to get up frequently at night to use the bathroom.

On the other hand, the other top prescribed medications, lisinopril, amlodipine, and losartan, all work differently and do not make you urinate. Thus, they can potentially be taken before bedtime if deemed appropriate by your healthcare provider.

Beyond your medication's timing, it is also important to follow all other recommendations by your healthcare provider for a heart-healthy lifestyle. 

Bottom Line 

Blood pressure control is important in order to reduce the burden of heart disease, heart attacks, and strokes. Engaging in a healthy lifestyle and taking the right medications can help improve blood pressure. Recent evidence also suggests that a simple regimen change may improve overall blood pressure control. More research is required to fully understand the optimal timing of blood pressure medications and associated benefits. 

Reference List

  1. What is Blood Pressure? Centers for Disease Control and Prevention. Updated May 19, 2020. Accessed September 22, 2020. https://www.cdc.gov/bloodpressure/about.htm
  2. Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. MillionHearts®. Centers for Disease Control and Prevention. Updated February 5, 2020. Accessed September 22, 2020. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
  3. My Life Check – Life’s Simple 7. American Heart Association. Reviewed May 2, 2018. Accessed September 22, 2020. https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7
  4. Types of Blood Pressure Medications. American Heart Association. Reviewed October 31, 2017. Accessed September 22, 2020. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications
  5. Hermida RC, Ayala DE, Fernández JR, et al. Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management. Heart Fail Clin. 2017;13(4):759-773. doi:10.1016/j.hfc.2017.05.010
  6. Hermida RC, Crespo JJ, Otero A, et al. Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for prevention. Eur Heart J. 2018;39(47):4159-4171. doi:10.1093/eurheartj/ehy475
  7. Bowles NP, Thosar SS, Herzig MX, Shea SA. Chronotherapy for Hypertension [published correction appears in Curr Hypertens Rep. 2018 Dec 4;21(1):1]. Curr Hypertens Rep. 2018;20(11):97. Published 2018 Sep 28. doi:10.1007/s11906-018-0897-4
  8. Kane SP. The Top 300 of 2020, ClinCalc DrugStats Database, Version 20.1. Updated June 29, 2020. Accessed September 22, 2020. https://clincalc.com/DrugStats/Top300Drugs.aspx

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Published October 13th, 2020 by Dr. Tomasz Jurga, PharmD, BCPS, BCACP, CDCES
Fact Checked by Chris Riley

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