What Time Should You Take Blood Pressure Medication?

Although simple lifestyle changes can help reduce blood pressure, you may also need to take medication. Your doctor might advise you to take medicine depending on your blood pressure readings and whether you are at risk of developing conditions such as a stroke or heart attack.

In cases where your blood pressure remains above 140/90mm Hg over a considerable time, a health expert may offer you medicine to help lower your blood pressure, especially if you are at risk of other health problems.

If you’re prescribed medication, you may wonder when is the best time to take it. Some people prefer taking their medicine in the morning while others take it at bedtime. This article will take a deep dive into the ideal time to take high blood pressure medication. 

Why is timing important when taking blood pressure medication?

According to CDC, approximately one in every three Americans suffers from hypertension, equivalent to about 67 million people.¹ Considering the medication, healthcare services, and the number of missed working days, the cost of this silent killer could be more than $198 billion per year. That's why it's essential to discuss with your doctor the most appropriate time of the day to take your medication to control hypertension. Proper timing of blood pressure medication also helps to reduce the risks of other illnesses such as cardiovascular events like heart attack, strokes, or even death.

When is blood pressure highest?

Generally, your blood pressure level follows a fairly predictable pattern. At night while sleeping, blood pressure drops, and then it surges in the morning when you wake up and keeps rising throughout the day.

However, this doesn't apply to all people. If you have high blood pressure, you will mostly have four patterns² at night as follows:

• A normal blood pressure drop of about 10%-20%

• An extreme drop that is more than 20%

• Nondipping, usually less than 10%

• Reverse dipping whereby your blood pressure rises at night than in the morning

Note that the abnormal dips can lead to different health risks affecting your blood sugar levels, kidneys, arteries and heart, and more. 

You can use the ambulatory blood pressure monitoring method to know how your blood pressure level changes. Try measuring your blood pressure at different periods of the night and day.

When is the best time of day to take blood pressure medication? 

People diagnosed with high blood pressure tend to take their medication in the morning. Since your heart rate and blood pressure are usually higher when waking up and lower when you sleep, this timing seems to make sense.

However, current research is increasingly pointing toward taking these medicines at bedtime. This is especially true from the angle of chronotherapy, an approach based on your body's natural cycle of physical changes every 24 hours, referred to as your ‘circadian rhythm.’ 

Health experts have also used this approach to determine the best timing to effectively treat other conditions like diabetes, chronic kidney disease, and sleep apnea.

A new study in Spain also suggests that taking high blood pressure medication at night is more effective than in the morning. The HYGIA chronotherapy trial³ included 19,168 patients aged 60 or older. Half of the patients took blood pressure medicines before bedtime; the other half when they woke up. 

Results showed that those who took medicines before bedtime controlled their blood pressure level better than those who took them at the other end of the day. They also had a 45% lower risk of heart-related illnesses or death. 

A close assessment showed that taking medication at night reduced the risk of:

• Heart attack by 44%

• Coronary revascularization (procedure to unblock arteries) by 40%

• Stroke by 49%

• Heart failure by 42%

This is the longest, largest trial examining the effects of different timings of antihypertensive medication on the possible risks of heart disease. 

Is it different for different people?

Despite a study showing that taking high blood pressure medication at night is more effective than in the morning, it doesn't work for everyone. In most cases, the trial may apply to patients with diabetes or sleep apnea because the blood pressure of those involved in the study tended to rise at night.

Each person is different, so blood pressure medicines do not work the same for everyone.

Can I change the time I take my blood pressure medication?

You can't just start taking your medication at nighttime because different medicines work in different ways.

For example, diuretics lower blood pressure by causing you to urinate out extra fluids. If you take a diuretic at ten o'clock in the evening, you might have to get up four hours later to go to the bathroom. A disruption to your sleep pattern could have negative health effects that may counterbalance the beneficial effect of the medication.

Beta-blockers are another group of blood pressure-lowering medications that reduce your heart rate. Since your heart rate typically goes down at night as you relax, taking beta-blockers at bedtime could cause your heart to beat too slowly. Therefore, it might be better to take these medicines in the morning when your heart rate is likely to be higher. 

If you are experiencing side effects of blood pressure medications during the day after taking specific medications in the morning, you can move them to bedtime.

For instance, amlodipine, which is commonly prescribed, works by dilating arteries, thereby reducing blood pressure and making it easier for your heart to pump blood. This medication doesn't affect your heart rate and doesn't make you urinate, so you can take it at bedtime.

Can I spread out the times I take my medication?

You might be prescribed more than one type of medication to control your blood pressure. Most people take all their medicines in the morning for convenience. However, this could make you feel unwell a few hours later if they lower your blood pressure too much.

To avoid this, your doctor may recommend that you stagger the medicines at different times of the day, depending on each drug's half-life (the time it takes for the drug’s active substance to reduce by half). 

For instance, if you have appointments or morning errands, you can take a diuretic in the afternoon when you are less busy or back home so you won’t be inconvenienced by the urge to use the bathroom.

The biggest drawback of taking medicines at different times is that you may forget to take the dose at the specified time. Failure to take a bedtime dose means you'll realize your mistake in the morning, seven or eight hours later, which might lead to adverse side effects. 

Therefore, before spreading out the time you take each medication, talk to your doctor. 

Some general rules on taking blood pressure medication correctly

When taking high blood pressure medication, keep the following guidelines in mind:

• You shouldn't consider naturopathic approaches as a substitute for prescription medications. If you are interested in natural remedies, discuss with your doctor whether there is such an option for blood pressure control for your condition.

• If you have high blood pressure symptoms, work with a healthcare provider to help you reach your treatment goals.

• Some over-the-counter drugs like decongestants can easily affect your blood pressure, so always seek medical advice before taking them.

• Follow your doctor's recommendations to enjoy the benefits of better health, even if you'll have to take medication for the rest of your life.

The lowdown

Studies have found some benefits to taking blood pressure medication at bedtime. One significant advantage is that they tend to wear off more slowly than during the day, and they reduce the risk of other associated illnesses. 

Ask your physician to recommend the optimum dosing schedule for you, based on your specific blood pressure and heart rate log.

If you use diuretics, your doctor may advise you to take them in the morning since they help your kidneys eliminate excess fluid, and visiting the bathroom during the night will interfere with your sleep cycle.

If you are unsure of when to take high blood pressure medication, consult your doctor about the advantage of taking a specific medication in the morning or at night. Also, if you want to spread out when you take different drugs, your healthcare provider can advise you on how best to achieve your goals.