The Best Time of Day To Take Your Blood Pressure Meds To Lower Your Heart Attack Risk, According to Cardiologists
If you're living with high blood pressure, taking your medication at a specific time of day may be second nature to you. And that's a good thing! When it comes to managing high blood pressure, the most important thing is that you take your medication at all.
"The ultimate goal is to lower blood pressures to lower the risk of strokes, heart attacks and kidney disease," says Dr. Hoang Nguyen, MD, a board-certified interventional cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center.
However, is there a best time to take blood pressure medication to reduce your odds of a heart attack? That's a great question.
"Blood pressure has natural swings throughout the day, and this varies for different patients," Dr. Nguyen explains. "Knowing when to take your medication may offer a tailored approach to your blood pressure control."
While it would be nice to have a black-and-white answer to an important question, cardiologists stress there isn't one. They shared their best practices for taking blood pressure medication, including timing and what to do if you miss a dose.
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Types of Blood Pressure Medications and What They Do
According to Dr. Bradley Serwer, MD, an interventional cardiologist and chief medical officer at VitalSolution, people can take various kinds of blood pressure medications. Each works differently, and Dr. Serwer says the most commonly prescribed blood pressure medications are:
Diuretics, which lower blood pressure directly by causing the kidney to produce more urine.
Beta-blockers, which slow down the heart and reduce the force of its contractions.
Ace Inhibitors, which block the formation of Angiotensin II, a chemical that causes blood vessels to constrict. "By blocking this chemical, the blood vessels dilate, causing lower pressure," Dr. Serwer says.
Calcium, which helps relax the heart and blood vessel.
Alpha-blockers, which prevent nerve signals from causing blood vessel constriction.
When To Take Blood Pressure Medication To Lower Heart Attack Risk, According to Cardiologists
There isn't a precise time of day to take blood pressure medication if you're trying to lower your heart attack risk. Traditionally, however, doctors have recommended people take blood pressure medication in the morning.
"Blood pressure tends to be higher during the day and lower at night, so I typically recommend taking blood pressure medications in the morning," Dr. Serwer explains.
Drs. Serwer and Nguyen advise people to take diuretics in the morning for another reason. "Thiazide diuretic medications should be taken in the morning hours to prevent frequent urination at nighttime, interfering with your sleep," Dr. Nguyen says.
Sleep is essential when managing or trying to ward off high blood pressure. A 2024 study linked getting too few hours of shut-eye with high blood pressure. However, some blood pressure medications have a side effect of making you feel sleepy during the day, regardless of how many Zzzs you get at night.
"Others, like beta blockers, can be taken at night to prevent the sensation of brain fog or grogginess," Dr. Nguyen says.
However, if brain fog and grogginess aren't issues for you, Dr. Serwer generally recommends taking beta-blockers in the morning to better manage blood pressure spikes.
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Yet, some recent evidence points to the idea that taking blood pressure medication at night might be best. For instance, a 2020 study of almost 20,000 people suggested that taking blood pressure medication at night could cut heart attack risk in half.
However, a study published in 2022 in The Lancet didn't find a difference in major cardiovascular events in patients who took blood pressure medication in the morning versus those who took it at night. In conclusion, the authors recommended that people take their medicines at the most convenient time for them.
Another factor to keep in mind in timing your blood pressure medication is how many of them you're taking. "Your physician may want to stagger your medications throughout the day so that you have a more even control of blood pressure and avoid side effects," Dr. Nguyen says. "Because the body has a natural up and down swing in blood pressure, it is usually better to spread out different classes of medications throughout the day."
However, Dr. Nguyen emphasizes, every person and every case is different. "It is best to consult your physician and ask for guidance. This process starts with taking a sample of blood pressure readings at home two to three times a day for one to two weeks to see what these swings are."
In short, "One size does not fit all," says Dr. Mohanakrishnan Sathyamoorthy, MD, FACC, the chair of internal medicine at Burnett School of Medicine at TCU.
What Happens if You Miss a Dose of Blood Pressure Medication?
Step one: Breathe. "Don’t panic if you miss a dose or are late," Dr. Serwer says. Your next steps will depend on how late you are.
"If you are one to two hours late, just take it when you remember," Dr. Serwer recommends. "If you are 18 hours late, skip it and take the normal scheduled dose at the next scheduled time."
It's generally best not to try to compensate by taking more medication than normal the following day.
"It is best never to double up to catch up on medicine," Dr. Sathyamoorthy warns. "Depending on each case and the type of medicine, it would be best to contact your physician to find out how to handle any specific situation."
Remembering to take medication can be challenging, but it's important—and in some cases, it's a matter of life or death. "If you find that you are missing your medicines frequently, I recommend setting an alarm on your phone or watch and carrying a pill box to remind you," Dr. Serwer says.
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Sources
Dr. Hoang Nguyen, MD, a board-certified interventional cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center
Dr. Bradley Serwer, MD, an interventional cardiologist and chief medical officer at VitalSolution
Association between sleep duration and hypertension incidence: Systematic review and meta-analysis of cohort studies. PLoS 1.
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. European Heart Journal.
Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet.
Dr. Mohanakrishnan Sathyamoorthy, MD, FACC, the chair of internal medicine at Burnett School of Medicine at TCU