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When Should You Take Your BP Pills? Morning or Bedtime?

Do you want the the biggest bang for your blood pressure buck? If so, you may want to ask your doctor whether you should take your BP pills before bed.
When Should You Take Your BP Pills? Morning or Bedtime?
Hypertension BP

Most people get into the habit of taking all their medications at breakfast time. It’s a routine that is hard to break. But a new study suggests bedtime might be a much better choice for some meds (European Heart Journal, Oct. 22, 2019). That’s because if you take your BP pills before bed, they appear to improve blood pressure control. More important, such a regimen reduces the risk of serious cardiovascular disease (CVD) events.

The Study:

In 2008, Spanish researchers undertook a fascinating study called the Hygia Chronotherapy Trial. It lasted a decade. The investigators recruited over 19,000 patients with hypertension in northern Spain. Half were randomly assigned to take their BP meds at bedtime. The other half took their drugs in the morning. The median patient follow-up was 6.3 years. This is one cool study!

The Results:

We always like to let researchers describe their results in their own words, if they are understandable.

Here’s what the Spanish investigators explained:

“Results establish, first, greater ABP [ambulatory blood pressure] control in patients of the bedtime treatment than in those of the awakening-treatment regimen. The main differences in ABP control were achievement with bedtime treatment of: (i) significantly lower asleep BP mean without loss of awake BP-lowering efficacy and (ii) greater sleep-time relative BP decline resulting in a significantly lower prevalence of non-dipping. These ingestion-time-dependent effects on asleep BP control were strongly associated with substantially attenuated CVD [cardiovascular disease] risk.”

OK, we admit, that’s a little technical. Here’s what they found in English. In a nutshell, taking blood pressure medicines before bed led to better blood pressure control during the night as well as during the daytime. More important, this regimen reduced morbidity and mortality. That’s doctor talk for less sickness and death.

A 2021 Update on when to take your BP Pills:

An analysis of 153 studies carried out over 45 years confirmed the Spanish research results (Advanced Drug Delivery Reviews, Jan. 22, 2021). The researchers reported that when hypertension medications were taken at bedtime/evening rather than upon-waking/morning there were fewer adverse drug reactions and better kidney function.

Drilling Down!

Did you know that your blood pressure normally goes down while you sleep? It hits its nadir (lowest point) between 2 and 4 am. There is also more activity with your renin–angiotensin–aldosterone system (RAAS) during sleep. You can learn more about why this is important at this link.

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Why should you take your BP meds at bedtime if they are ACE (angiotensin converting enzyme) inhibitors like lisinopril or ARBs (angiotensin receptor blockers) such as losartan or valsartan?

The reason is that the effect is more sustained:

“enhanced reduction in asleep BP mean without compromised therapeutic effect on awake BP.”

In the Spanish study, blood pressure was lower both during the day and while people were sleeping if they took their pills at night. This group also had a significant (45%) reduced risk of experiencing a major cardiovascular disaster. Stroke risk was reduced by 49%. Heart failure was diminished by 42% and heart attacks were 34% less common in the nighttime pill takers.

It’s always nice when a biomarker such as blood pressure measurement matches up with an outcome that people really care about, namely heart attack and stroke reduction. That’s not always the case.

But Is It Safe to Take Your BP Pills at Night?

The researchers wanted to know if you take your BP pills at night would it be safe?

Here are their conclusions:

“It also demonstrates that the safety of the bedtime hypertension therapeutic scheme is similar to the more common awakening one, a finding consistent with previous publications reporting that bedtime compared with morning BP therapy significantly improves ABP reduction without any increase in adverse effects.”

Before you decide to take your BP pills at night, you must check with the prescriber. There may be instances when an older person should not take hypertension medicine at night. If the pills contain a diuretic, you may have to get up more often to go to the bathroom at night. That can disturb sleep. If the medicine causes dizziness, that could increase the risk for a fall on the way to the bathroom. Please discuss any change in regimen with a health care professional!

To make that conversation fully informed, here is a link to the original Spanish research. And here is a link to the recent systematic review. Make sure your doctor, nurse practitioner or physician assistant reviews them carefully and considers your personal situation before giving you the green light to change your pill taking pattern.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
  • Hermida, R. C., et al, "Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial," European Heart Journal, Oct. 22, 2019, https://doi.org/10.1093/eurheartj/ehz754
  • Hermida, R.C., et al, "Ingestion-time differences in the pharmacodynamics of hypertension medications: Systematic review of human chronopharmacology trials," Advanced Drug Delivery Reviews, Jan. 22, 2021, DOI: 10.1016/j.addr.2021.01.013
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