When should you take your once daily BP meds?
Increasingly, the skeptical cardiologist has been recommending to patients that they take BP meds at bedtime as evidence has mounted that this does a better job of normalizing asleep blood pressure and minimizing daytime side effects.
Now a study published in European Heart Journal in October has demonstrated that routine ingestion of BP meds at bedtime as opposed to waking results in improved 24 hour BP control with enhanced decrease in asleep BP and increased sleep-time relative BP decline (known as BP dipping.)
More importantly, bedtime BP med ingestion in this randomized trial of over 19 thousand hypertensive Spaniards resulted in highly significant reductions in cardiovascular events including death, heart attack, heart failure and stroke over a 6 year median follow-up
The so-called Hygia Chronotherapy Trial was extremely well done and the results are powerful and should modify clinical practice immediately.
This figure demonstrates the dramatic and highly significant 45% reduction in all types of cardiovascular events measured. Note that stroke rate was halved!
Here are the Kaplan-Meier curves showing early and progressive separation of the treatment curves.
There was no difference side effects or compliance between the two groups.
The remarkable aspect of this intervention is that it costs nothing, introduces no new medications and has no increased side effects.
This study is practice-changing for me. We will be advising all hypertensive patients to take their once daily BP meds at bedtime.
Chronotherapically Yours,
-ACP
h/t Reader Lee Sacry for bringing this study to my attention