[acb-diabetics] takine blood pressure pills better at night time

[Patricia LaFrance-Wolf]

Issue 544

 

Blood Pressure Pills More Effective When Taken at Night

 

New research shows that timing blood pressure medication with a patient's
body clock makes it more effective and offers greater protection against the
occurrence

of heart attacks and strokes. The findings could change the hypertension
treatment for hundreds of millions of people worldwide....

 

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Chronobiology International -- the international journal on how biological
rhythms affect the systems of living things -- has published the results of
a

groundbreaking five-year study that will change the way blood pressure
medication is administered and have a profound impact on the type of
treatment that

hypertension patients receive. 

 

In two articles, Chronobiology International covers and interprets the newly
completed MAPEC study, which shows that the simple shift to taking
medication

at night instead of in the morning significantly increases efficacy in
keeping blood pressure within a healthy range. In addition, taking
medication at

night offers extra protection against heart attacks, strokes and other types
of cardiovascular diseases. 

 

Astonishingly, over the five-year study, the group of patients who took at
least one of their medications at night experienced just one-third of the
number

of cardiovascular disease (CVD) episodes experienced by the group of
patients who took all their medications in the morning. 

 

Lead investigator of the MAPEC Study, Professor Ramón C. Hermida, PhD,
Director of Bioengineering and Chronobiology Labs at the University of Vigo
in Spain

explains that, "This study proves that the time of day when patients take
their high blood pressure medications can make a huge difference due to the
effect

of the body's circadian rhythms on the actions of medications and because of
the importance of preserving the normal day-night pattern of blood pressure

in hypertension." 

 

"Conventional treatment typically advises taking blood pressure medications
in the morning. The MAPEC study shows that conventional treatment is not the

most effective way to help patients with high blood pressure," says
Professor Hermida. 

 

Taking at least one blood pressure medication at bedtime -- as opposed to
taking all medications in the morning -- was found, based on
around-the-clock

ambulatory blood pressure monitoring, to best normalize the sleep-time blood
pressure. This is known to be the most sensitive predictor of a patient's

5-year risk of CVD mortality. In addition, the MAPEC study shows that taking
medication at night is the best way to control daytime BP levels. 

 

The study also highlighted the importance of knowing a patient's sleep-time
blood pressure readings. While most hypertension patients can attest to the

fact that their BP reading is normally taken during a daytime clinic, not
knowing what a patient's blood pressure is doing over the entire 24-hour
period

-- and crucially, what the sleep-time readings register -- is like playing
Russian roulette with BP control. 

 

Historically, medical professionals have operated on the assumption that
sleep-time blood pressure levels will drop by 10-20% from daytime levels.
However,

for many patients -- called non-dippers -- this doesn't happen and
sleep-time therefore becomes a high risk period.

 

More than 70 million people in the US alone have hypertension. Millions
suffer heart attacks and strokes every year. Imagine if those CVD episodes
could

be cut by almost two thirds. Professor Hermida and his team are convinced
there is no time to lose. 

 

Dr. Francesco Portaluppi of the Hypertension Center at the University
Hospital of Ferrara in Italy continues, "This study was the first to
conclusively

find that the time of day when medications are ingested not only affects
efficacy but also CVD risk and these findings must fundamentally change the
way

patients are treated worldwide." Portaluppi and the team of experts who
analyzed the study results conclude that a number of steps should be taken
quickly

in order to best utilize the findings and save lives. 

 

First, 24-hour ambulatory blood pressure monitoring should be the proper
means of differentiating the needs of BP patients and the only means of
categorizing

patients as non-dippers in the 24-hour pattern. It is also the best means of
confirming that treatment goals of BP control are met, which include
ensuring

that sleep-time BP levels are in the correct range. 

 

Second, elevated sleep-time blood pressure should be made an important new
therapeutic clinical target for medications. Based on this and borne out by
the

results of the study, prescribing that hypertension medications be taken at
night offers an inexpensive and highly efficacious means of controlling
blood

pressure without the need to increase either the dose or number of
medications. 

 

"Our body clocks are extremely powerful biological tools and this study
offers insight and hard facts on how we can harness that power to help
millions

of people stay healthier and safer by ensuring that their blood pressure
medications are taken as effectively as possible," Dr. Michael Smolensky,
Editor

of Chronobiology International.

 

Chronobiology International, Oct. 2010: Influence of Circadian Time of
Hypertension Treatment on Cardiovascular Risk: Results of the MAPEC Study
was written

by: Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández.

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