Hypertension Meds Work Better When Taken Before Bed

Taking hypertension medications at bedtime can improve blood pressure control and reduce the risk of developing diabetes.

Pharmacists can play an important role in disseminating these new research findings, especially given their close and frequent contact with patients, study author Ramón C. Hermida, PhD, told Pharmacy Times.

“As a routine, [pharmacists] might ask their patients when they take their hypertension medications, and suggest that patients ask their physicians about taking such medications at bedtime,” he said.

For their study, Dr. Hermida and colleagues examined 2012 hypertensive patients without diabetes who were randomly assigned to take their entire daily dose of 1 or more hypertension medications either at bedtime or upon awakening.

After adjusting for factors such as waist circumference, fasting glucose, and chronic kidney disease, the researchers determined that those who took their medication before bed had a lower average sleeping blood pressure, greater sleep-time relative blood pressure decline, and lower rates of new-onset diabetes type 2 diabetes.

Patients on a treatment with angiotensin receptor blockers, angiotensin-converting-enzyme inhibitors, and beta-blockers saw greater benefit with the bedtime regimen than the waking regimen, as well.

“Changing the time of ingestion of hypertension medications—a no-cost intervention—has been shown to reduce cardiovascular morbidity and mortality, and in keeping with the new findings reported in Diabetologia, also reduces the risk of developing diabetes,” Dr. Hermida told Pharmacy Times.

This was the first trial to study a bedtime regimen of hypertension medications and the effects on blood pressure control and diabetes risk, the study authors claimed.

A companion article titled “Sleep-time BP: prognostic marker of type 2 diabetes and therapeutic target for prevention” added that lowering asleep blood pressure may also reduce the risk of developing diabetes.

In light of these additional findings, pharmacists “might well inform patients on the need to evaluate their blood pressure during sleep as a means to properly identify those individuals in need of proper treatment,” Dr. Hermida said.