Doctors sometimes advise people on medication for hypertension to take their daily pills when they wake up in the morning, since blood pressure tends to be higher in the morning than at night. But you’re likely to get better results by taking the drugs at night, according to a recent study of Spanish adults published in October 2019 in the European Heart Journal.
In the largest—and longest—clinical trial to date to examine how the timing of blood pressure medication influences its effectiveness (called chronotherapy), the researchers randomized 19,084 adults taking at least one medication for hypertension—a beta blocker, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker, or diuretic—to take their pills either when they woke up in the morning or before going to bed at night.
During an average follow-up of six years, the bedtime group not only had better overnight blood pressure control but also was substantially less likely to experience a major cardiovascular event (heart attack, stroke, heart failure, or the need for a procedure to reopen blocked arteries) or to die from cardiovascular disease, compared to those who took their medication upon waking (622 events or deaths in the bedtime group versus 1,130 in the morning group).
The new study adds to earlier evidence showing that bedtime offers an edge over morning for maximizing blood pressure drugs’ effectiveness. A 2016 study by the same lead researcher found that taking the medications before bedtime both improved blood pressure control and reduced the risk of type 2 diabetes. In 2011, a review from the Cochrane Collaboration evaluated 21 studies and found that taking the drugs in the evening resulted in slightly lower 24-hour blood pressure readings. And a Spanish study of 611 people with hypertension and chronic kidney disease, also in 2011, found that those who were told to take at least one hypertension drug at bedtime had better blood pressure control as well as far fewer heart attacks, strokes, and other cardiovascular events over five years than those taking the drugs in the morning.
Current blood pressure treatment guidelines don’t recommend any particular time of day for taking hypertension medications, leaving the choice up to doctors and their patients.