From the Guidelines
There are no blood pressure medications that are recommended to be taken specifically at bedtime to manage high morning blood pressure readings, as the preferential use of antihypertensives at bedtime is not recommended according to the most recent guidelines 1. When considering medications to help manage high morning blood pressure readings, it's essential to focus on long-acting antihypertensive medications that can provide 24-hour coverage.
- Chlorthalidone, a long-acting thiazide-like diuretic, can be effective with effects lasting 24-48 hours.
- Long-acting ACE inhibitors like lisinopril or ARBs such as olmesartan or telmisartan are also good options.
- Amlodipine, a calcium channel blocker with a 24-hour duration, can be effective as well. However, the timing of these medications should be determined based on individual patient needs and in consultation with a healthcare provider, rather than a specific bedtime dosing strategy 1. The approach of taking medications at bedtime to target the early morning blood pressure surge, known as chronotherapy, may not be supported by the most recent evidence, and therefore, the decision to take any medication at bedtime should be made with caution and under the guidance of a healthcare professional.
From the FDA Drug Label
Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents. Losartan may be administered with other antihypertensive agents.
BP Medications that could help with a patient who has very high bp readings when they are taken just before his first dose in the morning include:
- Amlodipine: Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents, and its effects can last for 24 hours, which may help control blood pressure throughout the night and into the morning 2.
- Losartan: Losartan may be administered with other antihypertensive agents, and it has a duration of action that can last for 24 hours, which may help control blood pressure throughout the night and into the morning 3.
It is possible that taking these medications before bed could still have an effect until the patient wakes up, but the exact duration of action may vary depending on individual factors.
From the Research
BP Medications for High Morning Readings
To address high blood pressure readings in the morning, several medication options can be considered:
- Long-acting antihypertensive drugs, which can be taken in the evening to help control morning blood pressure, as suggested by 4
- Combination therapies, such as angiotensin II receptor blockers (ARBs) with calcium channel blockers (CCBs) and/or thiazide diuretics, which have been shown to be effective in lowering blood pressure, as discussed in 5
- Specific medications like losartan, amlodipine, and hydrochlorothiazide, which have been studied in various combinations for their efficacy in controlling blood pressure, as reported in 6, 7, and 8
Medication Timing and Efficacy
The timing of medication intake can impact its efficacy in controlling morning blood pressure:
- Taking medication in the evening can help maintain its effects throughout the night and into the morning, as implied by 4
- The choice of medication and its dosage can also influence its ability to control morning blood pressure, as shown in studies comparing different combinations of ARBs, CCBs, and diuretics, such as 5, 6, 7, and 8
Considerations for Combination Therapies
When selecting a combination therapy, several factors should be considered: