November 18, 2019
Many of you might have already come across this invaluable piece of information published in the New York Times and elsewhere. From a physician's perspective, this is a game-changer.
From a patient's perspective, this will help you stay alive and healthier longer and reduce your risks of both heart disease and stroke.Before I get into the nitty-gritty of this article, it would be worth saying a few words about hypertension or high blood pressure.
Normal blood pressure for most adults is considered a systolic blood pressure (the top number) of less than 120 and a diastolic blood pressure (the bottom number) of less than 80 mmHg. (2017 Revised guidelines from the American Heart Association and College of Cardiology)
Anything above is considered elevated blood pressure or hypertension... In reality, this definition is far more nuanced than what I have stated above. But for the purposes of this discussion, it has relevance and should suffice.The prevalence of hypertension using the 2017 guidelines is significant. One estimate is that 46% of all adults 20 years and older have high blood pressure. This equates to approximately 103 million adults or a third of the US population.
Untreated hypertension is a major risk factor for premature cardiovascular disease, stroke, and chronic kidney disease. From a cardiovascular standpoint, it is the most important modifiable risk factor as compared to everything else including smoking, diabetes, high cholesterol, etc. The above trial involved 19084 patients and had a median follow up period of 6.3 years. Half the participants were given their entire daily dose of blood pressure medications at bedtime and the other half upon awakening.
During the follow-up period,1752 participants (approximately 1131 in the morning group and 621 in the bedtime group) experienced the primary cardiovascular outcome ( death 310, heart attack 274, coronary revascularization 302, heart failure 521 or stroke 345.). Overall blood pressure control was better in the group taking their medications at bedtime which resulted in a 45% reduction in the cardiovascular outcome.
This is a big deal because such differences are hard to reproduce with novel therapies or even with the best combinations of drugs available today. The strategy was simple, painless and effective.
Beyond the differences in the outcome stated above, bedtime therapeutic strategy was also associated with an improvement in kidney function, lower bad cholesterol and higher good cholesterol, and a lower heart rate, and was just as safe as taking your blood pressure medications upon awakening.
To summarize the results of this study, if you take all your blood pressure medications at bedtime instead of upon awakening, you stand a better chance of survival, with less risk of having a heart attack, heart failure, cardiovascular revascularization (angioplasty with stent or bypass surgery) or a stroke and at no extra cost or greater side effects.
Published on October 22nd in the European Heart Journal
