In mainland China, hypertension is a very common chronic disease, data show that in mainland China, on average, there is an average of one in every four people with hypertension, and the most terrible thing about hypertension is its complications.
A lot of people with high blood pressure will say, "Doctor, even though I have high blood pressure, I don't seem to have any symptoms."
High blood pressure is a silent killer, elevated blood pressure, maybe a day or two will not cause any effect on the body, but a year or two, for a long time, if the blood pressure is not well controlled, the impact on the body will be fatal, high blood pressure will produce a series of chronic complications, including hypertensive nephropathy, hypertensive heart disease and stroke, these complications once they appear, often irreversible.
Therefore, many people usually do not pay attention to high blood pressure, and do not pay attention to it until the complications are discovered, but they do not know that at this time, it is often too late.
Doctors will advise patients with high blood pressure to take antihypertensive drugs on time, and at the same time change unhealthy lifestyle habits, including quitting smoking and drinking, eating a low-salt and low-fat diet, insisting on exercise, not staying up late, developing regular work and rest habits, and maintaining adequate sleep.
However, the most important thing is the first one, take antihypertensive drugs on time, which is the most immediate way to treat high blood pressure, but taking medicine, not to say that it is enough to eat for a day or two, but to take it for a long time.
As for taking antihypertensive drugs, it is also necessary to pay attention to science, some patients with high blood pressure only need to take one antihypertensive drug, and some need a combination of several antihypertensive drugs.
But with all kinds of blood pressure medications, should they be taken well in the morning or at night?
Different people have different answers, some people think that it is better to eat in the morning, because the blood pressure during the day is generally higher than at night, to control high blood pressure, it is natural to control the blood pressure during the day, and some people think that it is better to eat at night.
The Hygia Temporal Therapy trial, published in 2019, was a multicenter, prospective, randomized controlled study that included a total of 19,084 hypertensive patients (10,614 men/8,470 women, 60.5±13.7 years) who were divided into two groups in a 1:1 ratio and given a total daily dose of ≥ 1 antihypertensive drug at bedtime (n=9552) or in the morning (n=9532).
At a median follow-up of 6.3 years, 1752 patients experienced major cardiovascular outcomes (a composite event of cardiovascular death, myocardial infarction, coronary revascularization, heart failure, or stroke). After adjusting for age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL-C, mean sleep systolic blood pressure, sleep time relative systolic blood pressure, and prior CVD events, the results showed a 45% lower risk of major cardiovascular events, a 49% lower risk of stroke, a 34% lower risk of myocardial infarction, a 40% lower risk of coronary revascularization, a 42% lower risk of heart failure, and a 56% lower risk of cardiovascular death in patients who took the drug at bedtime at night.
The study's recommendation is that it is better to take blood pressure medication at night.
However, after the release of this study, it quickly aroused heated discussions in the medical community, with some agreeing and some opposing.
The TIME study published in ESC2022 found different results, including a total of 21,104 patients with high blood pressure, including 10,503 who took medication at night before bed and 10,601 who got up in the morning, with an average age of 65 years, 58% male and 98% white. The results of the study showed that taking the drug at bedtime in the evening did not improve the primary endpoint of hospitalization for non-fatal myocardial infarction, non-fatal stroke, or vascular death compared with taking the drug in the morning, which means that no harm to the body was found when taking the drug at bedtime in the evening. Given that the timing of dosing has no effect on cardiovascular outcomes, patients can take antihypertensive drugs in the morning or evening.
Therefore, you can see that whether to take medicine in the morning or at night is actually debated in the medical community.
As a doctor, I often say to the patients I manage with high blood pressure that it is advisable to take medication in the morning.
The reason why I recommend taking medicine in the morning is because the morning is a special time period, and the sympathetic nervous system is excited in the morning, so the first peak stage of blood pressure will soon be ushered in, and taking antihypertensive drugs in time in the morning can cope well with the sharp increase in blood pressure.
The reason is that people's blood pressure at night is lower than during the day, some people with high blood pressure, high blood pressure during the day, but normal blood pressure at night, if you take antihypertensive drugs before bedtime, it may lower blood pressure, which is easy to bring risks.
Also, the most important point is to monitor blood pressure dynamically, it is recommended that patients with high blood pressure should measure their blood pressure three times a day, the first time the blood pressure is in the morning, the second time the blood pressure is at 2 o'clock in the afternoon, and the third blood pressure is at bedtime.
Why monitor blood pressure dynamically?
The aim is to better detect changes in blood pressure so that better interventions can be made.