Controlling blood pressure is
important to prevent strokes, heart and kidney damage.
A recent study in people
with diabetes showed that taking blood pressure medications at bedtime rather
than in the morning might be best.
Control of blood pressure during
sleep and throughout the day may be more important than just the daytime blood
pressure measured at your doctor’s office. Ambulatory blood pressure monitoring
with devices that measure blood pressure automatically every 15-30 minutes over
a 24-48 hour period have been used in recent studies.
This recent trial followed 448
adults with Type 2 Diabetes on high blood pressure medications. The researchers
randomly assigned each person to take their blood pressure medication either in
the morning or at bedtime. They followed the patients for up to 8 years (median
follow up of 5.4 years).
The researchers used ambulatory
blood pressure monitoring at least every year during the study. Office blood
pressure measurements and measurements found on the ambulatory blood pressure
monitoring were used to adjust blood pressure medications.
So what did these researchers find?
First they found better control of blood pressure during sleep in those taking
blood pressure medications at bedtime. That's not too surprising.
But their other findings were really
striking!
The risk of suffering a
cardiovascular event such as a stroke or heart attack or heart failure was 67%
less in the group taking blood pressure medications at bedtime. Every 5 mm Hg
(that’s millimeters of mercury, the units we measure the blood pressure)
decrease in systolic blood pressure during sleep corresponded to a 12%
reduction in cardiovascular risk.
Keep in mind that this study used
ambulatory blood pressure monitoring to guide treatment of people with Type 2
Diabetes and high blood pressure.
Unfortunately, ambulatory blood
pressure monitoring is seldom used in the U.S..
Why’s that? Largely because ambulatory blood pressure monitoring
is not usually reimbursed by Medicare or other insurances.
If you have been diagnosed with high
blood pressure, Medicare will not cover ambulatory blood pressure monitoring.
The impressive results of this
study need to be confirmed in a larger trial.
But at a minimum it seems to support
taking blood pressure medications at bedtime.
This study and others also support the
use of ambulatory blood pressure monitoring to diagnose and manage high blood
pressure.
We plan to start
using ambulatory blood pressure monitoring in our office soon, despite the
reimbursement challenges.
"Controlling blood pressure is important to prevent strokes, heart and kidney damage." Which is prevalent in offices, especially because of the stress of working and doing the daily rounds of tasks required.
ReplyDeleteAs a note to parents, you should watch the blood pressure of your children at the earliest possible time. This is to prevent complications in the future.
ReplyDeleteBedtime has to be the most relaxed hour of your daily life, anyway. No need to complicate it with medical procedures.
ReplyDeleteYou should still follow the advice of your doctor. Don't choose to take medicine exclusively at night just because you think it will have a better effect.
ReplyDeleteI agree. Check with your physician before making this change. Ambulatory blood pressure monitoring was used in this study and may be very useful before and after you make a change in meds.
ReplyDelete