Should blood pressure medication be taken in the morning or evening?
Published Feb 1, 2015 · Trefor Owen Morgan
Journal of hypertension
3
Citations
1
Influential Citations
Abstract
S leep blood pressure (BP) is a powerful predictor of cardiovascular complications, and there is suggestive evidence that controlling BP during sleep has beneficial outcomes. When drugs are given in the morning, the drug concentration may be lowest at the time when good BP control is desirable. This has led to the idea that it may be preferable to give medication in the evening. The study by Zappe et al. [1] is an important contribution to the question when should drugs that act on the renin– angiotensin system (RAS) be administered. Is there an advantage of night-time over morning administration as some studies have suggested? [2,3] Their study [1] clearly shows that when an angiotensin-receptor blocking (ARB) drug is administered in a dose that has a full 24-h duration of effect (valsartan 320 mg), the time of administration has little influence on the 24 h, day or sleep BP reduction. This was true in people who were on monotherapy and also in people in whom addition of a diuretic was needed. Hermida and Ayala, and their group [2–4] have written extensively on this subject, and come down in favour of nocturnal dosing independent of the dose and the agent. The present study would appear to be in conflict with their results with valsartan 160 mg [4]. This difference is more apparent than real. In the study with valsartan 160 mg, Hermida et al. claim superiority of nocturnal dosing over awakening dosage. However, there were similar falls in 24-h ambulatory blood pressure and night-time (sleep) BP. The superiority was based on an increase in the diurnal nocturnal BP ratio which, in their study, was due to a greater fall in daytime BP with the morning dose as compared to the nocturnal dose. Their studies [2–4] and the present study [1] compared fixed doses of medication taken in the morning and evening. Whereas the conclusions are important, they do not address the real-life problem. When therapy is started and titrated according to clinic BP response, is it better to take a medication that blocks the RAS in the morning or evening?