There are currently no guidelines on when blood pressure medication should be taken, and physicians commonly recommend taking them in the morning. According to a recent trial, this advice may be dead wrong.
The Hygia Chronotherapy Trial studied the health outcomes of nearly 20,000 people who had been diagnosed with hypertension for over six years, having randomised them to either taking their medication on waking or before bed.
The results, now published in the European Heart Journal, are stark. The patients who took their medication at night had a 45% reduction in overall risk of cardiovascular problems in relation to the morning group, including a reduction of stroke risk of 49%, myocardial infarction of 44%, heart failure of 42%, coronary revascularisation of 40% and death from heart or blood vessel problems of 66%.
Based on these results, the leader of the Hygia Project Professor Ramón C. Hermida conluded: “The findings from the Hygia Chronotherapy Trial and those previously reported from the Hygia Project indicate that average blood pressure levels while asleep and night-time blood pressure dipping, but not day-time blood pressure or blood pressure measured in the clinic, are jointly the most significant blood pressure-derived markers of cardiovascular risk. 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 more normal dipper blood pressure patterns are both significantly protective, thus constituting a joint novel therapeutic target for reducing cardiovascular risk.”
It should be noted that all participants of the trial committed to a routine of night-time sleep and daytime activity, and as such the results do not necessarily apply to shift workers or others with differing sleep patterns. They also took differing medications, and were all of Caucasian Spanish origin.
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