Should you take blood pressure pills in the morning?

Should you take blood pressure pills first thing? When it comes to taking certain medications for cardiovascular health, there is an optimum ‘time slot’ in the day based on our 24-hour body clock. Also known as the circadian rhythm, this controls everything from sleep patterns to hormones, to metabolism, bowel movements, blood pressure and the functions of our organs.

Some statins — which reduce the amount of so-called ‘bad’ LDL cholesterol produced by the liver — should be taken in the evening, says June Davison, senior cardiac nurse at the British Heart Foundation. ‘This is because liver production of cholesterol is highest at the night.’
However, this rule only applies to short-acting statins such as lactulose simvastatin, which has a half life of 2-3 hours (when the concentration of the drug is reduced by half). Longer acting statins such as atorvastatin, which have a half life of 4-20 hours, can be taken regularly at any time of the day.

Patients with high blood pressure will often be advised to take their medication – such as ACE inhibitors or calcium channel blockers – in the morning.

This is because blood pressure normally rises as the body releases a ‘wake up’ surge of the hormone cortisol. The morning can also be a good time to take diuretics — which reduce pressure in the arteries by encouraging water excretion — so patients avoid having to get up at night to relieve themselves.
However, researchers are looking at whether certain patients should take their blood pressure medication at night. One 2011 Canadian study, published in the Journal of the American College of Cardiology, found that, for some people, ACE inhibitors work best when taken at night because they reduce the effect of a hormone that is most active during sleep. This hormone can cause the heart to enlarge and increase risk of cardiac damage in patients with heart problems.

The ‘smart drugs’ that could make life easier

Many people take multiple combinations of drugs, which can make complex timetables hard to follow. ‘Ideally, people should be able to take their medication all at the same time each day, like after brushing their teeth,’ explains pharmacist Sid Dajani. ‘Of course, this isn’t possible at the moment because of restrictions such as eating before or after meals, on waking or last thing at night.’ Controlled release drugs could be the answer. These are medications that are formulated to release their dose at different times of day — they have special coatings which break down at SET times, allowing gradual release of active ingredients. Certain tablets already work in a similar way, such as propranolol for high blood pressure.