When Should You Take Blood Pressure Medication?
Key takeaways:
Ongoing research shows that there isn’t a single “best time of day” to take blood pressure medication.
The most important factor in deciding when to take your blood pressure medication each day, is to take it at a time when you can consistently remember every day.
Some factors — like side effects or a history of falls — can help in deciding the best time for you to take your blood pressure medication each day.
Table of contents
There’s some debate in the medical community about whether blood pressure medication works better in the morning or at night. Traditionally, you’d be encouraged to take blood pressure medication as part of your morning routine. But some scientific evidence shows it may be better to take it at night.
The research is still unclear. But most experts agree that taking your blood pressure medication at the same time every day is more important than whether you take it in the morning or at night.
What time of the day is blood pressure highest?
For most people, blood pressure usually starts to rise around the time they wake up. It goes up more during your morning routine and peaks sometime around midday. In the evening, blood pressure starts to lower. At night, most people’s blood pressure is usually 10% to 20% lower than during the day.
Abnormal blood pressure patterns
Not everyone has the typical rise in blood pressure during the day and dip at night. For example, some people have higher blood pressure when they’re asleep than when they’re awake.
Examples of these unusual or abnormal blood pressure patterns include:
Reverse dippers: Higher blood pressure at night than during the day
Nondippers: Blood pressure that doesn’t drop overnight
Extreme dippers: Very low blood pressure at night
It can be hard to know which blood pressure medication is best. This guide can help you learn more about your treatment options.
Some blood pressure medications can be expensive. Here’s a list of popular generic blood pressure medications and how they work.
Are you taking multiple blood pressure pills? These combination medications may help decrease the number of medications you have to take each day.
People with these abnormal blood pressure patterns have a higher risk of heart disease. That’s especially true for those with high blood pressure at night. They’re also more likely to have:
High blood pressure that’s difficult to treat
A diagnosis of overweight or obesity
Habits such as cigarette smoking
What does the science say about taking blood pressure medication at night vs. the morning?
Right now, there are no formal guidelines for when people should take blood pressure medication. This means the evidence isn’t strong enough for experts to decide the “right” time for people to take blood pressure medications. So, the decision is usually left up to each individual and their healthcare team.
Still, some scientists feel strongly that timing matters for high blood pressure treatment. They call this idea “chronotherapy.” Most of these experts think it’s better for your heart and vascular health to take blood pressure medication at night instead of in the morning.
Evidence for taking blood pressure medication at night
Experts who support chronotherapy think that high blood pressure during sleep is common. Studies show that people with higher blood pressure at night have a higher risk of heart disease. And they may even have a higher risk of death from these problems. Because of this, they think people should take blood pressure medication at night.
Evidence for taking blood pressure medication in the morning
There are also some good reasons to take blood pressure medications in the morning — especially for older adults.
Lowering blood pressure too much at night can be risky:
Having very low blood pressure at night, followed by a morning surge, may actually raise cardiovascular risk. This is compared to those who just have high blood pressure at night.
Low blood pressure at night has been linked to a greater risk of stroke in older people.
Older adults with low blood pressure when standing are more likely to feel weak or fall — especially at night.
Studies have also linked low blood pressure at night to an increased risk of heart muscle damage in people with coronary artery disease (CAD). So, for older adults or people with CAD, taking blood pressure medication in the morning might be safer.
Many experts argue that there isn’t enough evidence to switch blood pressure medications from morning to nighttime. Until there’s stronger data otherwise, it’s advised to keep taking your blood pressure medication in the morning, until there’s stronger data otherwise.
Evidence that it may not matter when you take your blood pressure medication (as long as you take it)
The HARMONY trial is one of the strongest studies we have on this topic. In this study, people were randomly assigned to take their blood pressure medication either in the morning or at night. Halfway through the study, participants switched to the other group.
Researchers found that the time of day didn’t affect their average blood pressure.
Similarly, the TIME study and BedMed study were large, robust trials that also looked at the risks and benefits of taking blood pressure medication at night versus in the morning. These studies showed that there was no advantage to taking blood pressure medication at night and timing can be based on personal preference.
So, when’s the best time to take my blood pressure medication?
The best time to take your blood pressure medication is when you’ll remember to take it. Just take your blood pressure medication every single day, at the same time. This routine is the best way to keep your blood pressure levels within normal limits. It also supports the long-term health of your heart and blood vessels.
Everyone’s situation is different, so there may be a good reason for you to take your medication at a particular time of day. That’s why it’s important to keep open communication with your healthcare team. That means letting them know about any medication side effects, your sleep patterns, or if you’ve had a history of falls at night. All of these things matter when you and your prescriber decide when it’s best for you to take your blood pressure medication.
Frequently asked questions
Blood pressure changes throughout the day to meet the body’s needs. For most people, blood pressure levels follow the circadian rhythm — the 24-hour cycle that regulates your sleep/wake pattern.
Your circadian rhythm is regulated by hormones like adrenaline and noradrenaline. These hormones increase blood pressure first thing in the morning, which is known as the “morning surge.” Another hormone, melatonin, helps lower your blood pressure at night.
The time it takes for blood pressure medication to work depends on the type of medication and the dose. Your age, weight, and any other medications you take also play a role.
Some medications — like clonidine, captopril, labetalol, and nifedipine — start to work quite rapidly, within minutes. Others — like amlodipine and hydrochlorothiazide — can take hours before they have an effect.
It depends on what blood pressure medications you take, but the most common ones work for a full 24 hours and are taken once a day.
Examples of common blood pressure medications designed to last 24 hours include:
ACE inhibitors (lisinopril and benazepril)
Angiotensin II receptor blockers (losartan and candesartan)
Calcium channel blockers (amlodipine and nifedipine ER)
Diuretics (hydrochlorothiazide and chlorthalidone)
Some people taking these once-a-day medications find that their blood pressure varies or creeps up toward the end of the 24-hour period. If this happens to you, talk with your healthcare team. You may need to take a higher dose, change your medication, or take it at a different time.
The bottom line
Based on current evidence, there’s no “ideal” time to take your blood pressure medication. In some cases, taking your blood pressure at a certain time may be beneficial. But it’s not likely to have an effect on your heart health. In general, the best time to take your medication is when you can best remember — and at a time when you and your prescriber agree is best for your situation.
Why trust our experts?
References
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