Sunday, October 9, 2011

Taking Blood Pressure Medications at Bedtime


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.

Your Diabetes Endocrine Nutrition Group



5 comments:

  1. "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.

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  2. As 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.

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  3. Bedtime has to be the most relaxed hour of your daily life, anyway. No need to complicate it with medical procedures.

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  4. You 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.

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  5. I 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.

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