Taking Your Heart Pills. New Bedtime Routine?

By Julie Vargo, Editorial Contributor

If you are among the 75 million Americans who routinely take blood pressure medicine every morning, it’s time to consider switching it up. Taking your pills before bedtime may actually be better for you, according to new research published in the European Heart Journal.

The study, which followed more than 19,000 patients for six years, found taking medicine for high blood pressure at night cut the risk of dying from heart problems nearly in half. The threat of stroke dropped by 49 percent. Myocardial infarction risk went down by 44 percent, heart failure fell 42 percent and coronary revascularization by 40 percent.

“The idea of taking blood pressure medicine before bed makes sense,” says Dr. Farhan J. Khawaja, an interventional cardiologist with the Orlando Health Heart & Vascular Institute. “Most heart attacks take place in the morning. We already recommend taking statins at night for patients who need them. This falls in line with those recommendations.”

Silent and Deadly

High blood pressure, or hypertension, affects one in three Americans and causes the heart to work harder to pump the blood through the body. Unless the pressure is very high, the disease doesn’t manifest in a lot of symptoms, giving it the nickname “silent killer.”

“Most people don’t check their blood pressure daily and don’t know if it’s high or not,” says Dr. Khawaja.

“Hypertension can cause a host of problems like stroke, heart failure, coronary artery disease, and renal and kidney disease. So it is vital to keep blood pressure in check to reduce the complications of those medical conditions.”

Fortunately, a number of steps can be taken to help normalize blood pressure. Borderline hypertension is first treated with lifestyle changes like reducing caffeine, salt and alcohol intake, increasing sleep and exercise and maintaining a healthy weight. When that doesn’t work, doctors prescribe medicine, often two or more types.

Shift Change

Taking your medication consistently is key to therapy success. “If you are hit-and-miss with any medication day or night, it’s not going to be very effective,” says Dr. Khawaja.

In the past, doctors recommended adhering to a morning medication schedule. The new data suggests a night shift. If you are recently diagnosed with hypertension, work with your doctor to start your dosing regimen at bedtime. For those already in a morning routine, Dr. Khawaja suggests transitioning in conjunction with your physician’s help.

“Most patients take more than one type of blood pressure medication,” says the doctor, who suggests staggering your pill consumption to start. “Following your doctor’s recommendations, take one pill in the morning as you have been doing and move the other to the evening. Once you have established that routine, you can consider moving the next to the evening as well.”

If you take a diuretic as part of your regimen, you may find yourself getting up to go to the bathroom in the middle of the night when you first move the medication to bedtime. “This may affect patients just starting a blood pressure regimen more so than those already on pills,” says Dr. Khawaja. “But after a few weeks, this progressively becomes less of a problem.”

Making the Move

Successfully shifting blood pressure medication from day to night — without forgetting — works best when you can fit it into your existing routine. For example, keep your medication beside your toothbrush or combine taking it with putting on your pajamas.

Some other tips include:

  • Put your medication in a weekly pillbox with a compartment for each day, then set it on your bedside table where you will see it each night. There are even pill dispensers with alarms that beep or vibrate when it’s time to pop your pills.

  • For a more high-tech method of medication management, go digital. Set up electronic text or email dosage alerts on your smart phone.

  • Pill reminder apps available in the App Store or Google Play offer another option, complete with alarms, weekly prescription tracking, notes and reminders for refills.

  • Enlist a loved one to remind you to take your medicines with a nightly phone call or text message.

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