Chasing better odds: BP meds at night?

Recently I came across a study, the result so fantastic that my first reaction was – it’s too good to be true.

But curiosity got the better of me. I tracked down the article and read it. (It was either that or rake leaves.)

Published in the October issue of the European Heart Journal, the study has a pretty name: Hygia (the Greek goddess of health) Chronotherapy Trial. And a simple goal: Compare health outcomes between taking blood pressure (BP) medications at bedtime and in the morning. Drugs are once-daily.

The researchers followed tens of thousands of people for about six years. Astoundingly, when compared to morning-pill-poppers, bedtime-pill-poppers had half the rate of heart attacks, strokes and deaths.

Half? Just by taking pills at night?

I’ll let you in on a trade secret.

A cardiologist’s best weapon, statins (cholesterol-lowering pills like pravastatin, atorvastatin, etc.), reduce heart attack rate by about half, at best.  

The researchers have a plausible biological basis for their claims. During sleep, BP dips to the lowest point of the day. It turns out this dip is a better predictor of heart disease than daytime BP readings. That is, those with insufficient drop in nighttime BP (for whatever reason) have a higher risk of heart disease.

They concluded: Taking “BP-lowering medications at bedtime, as opposed to upon waking, results in improved ... BP dipping, and most importantly, markedly diminished occurrence of major [cardiovascular disease] events.”

My take: This study is a lone wolf – albeit a good-sized wolf worth its howl. There are other ongoing studies that address the same issue.

Meanwhile, I’m thinking: Lipitor, the most expensive statin, costs around $4,000 a year (not counting the cost of blood tests and side effects). Switching BP meds from morning to night costs $0. If it’s six versus half a dozen, I’d switch.

Can you switch tonight?

Call your doctor first. Some people with glaucoma or at high risk for falling, might be sensitive to a further or sudden drop in nighttime BP.

Of less concern: “water pills” or diuretics. We have different kinds of diuretics. The BP-controlling diuretics (hydrochlorothiazide, chlorthalidone, etc.) differ from the heart-failure diuretics (furosemide or Lasix). The former controls BP better and dry you out less than the latter. Taking them at bedtime may not increase your bathroom trips at night. About 40 percent of Hygia Trial participants took diuretics. If it bothers you, take diuretics in the morning, the rest at night.

More importantly: Remember to take your pills at the same time every day. BP can fluctuate wildly if you miss or delay taking pills. Piggyback pill-taking onto your daily routine. For example, if you always brush your teeth before bedtime, put the pill bottles next to the toothbrush.

Do I have other heart-friendly advice?

Yes, it’s a trick question! You know how I feel about high-fiber diet, exercise, sleep and stress management. Per recent data, poor diet just beat out smoking as the leading cause of death in the U.S.

Unfortunately, this won't be the last time I talk about it.

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Volume 11, Issue 21, Posted 9:29 AM, 11.05.2019