From the Guidelines
The best time to administer 3 antihypertensive medications is typically at the same time, once daily, to improve medication adherence and simplify the regimen, as supported by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. When considering the administration of multiple antihypertensive medications, several factors come into play, including the type of medication, its duration of action, side effect profile, and the patient's daily blood pressure pattern.
- Medication adherence is a crucial aspect of blood pressure management, and simplifying the regimen can significantly improve adherence, with once-daily dosing showing the highest adherence rates, ranging from 71% to 94% 1.
- While some medications may be better taken at specific times of the day, such as diuretics in the morning to avoid nighttime urination, the overall goal is to maintain a consistent schedule and minimize the risk of side effects.
- The 2021 standards of medical care in diabetes also suggest that bedtime dosing of antihypertensive medications may have a small benefit in terms of blood pressure control, but the evidence is not strong enough to make a definitive recommendation 1.
- In general, it is essential to consult with a healthcare provider to determine the optimal timing for a specific medication regimen, taking into account individual factors such as blood pressure pattern and medication types.
- The use of fixed-dose combination therapy can also simplify the regimen and improve adherence, as listed in the Online Data Supplement D of the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Administration Timing of Antihypertensive Medications
- The optimal timing for administering antihypertensive medications is still a topic of debate 2.
- Some studies suggest that nighttime dosing achieves better blood pressure control and significantly lowers cardiovascular events 3, 2.
- However, other studies found no significant difference in blood pressure control or cardiovascular outcomes between daytime and nighttime dosing 2, 4.
- The decision about the timing of antihypertensive medications administration should be individualized, taking into account patient preference and clinical context, in order to promote consistent compliance 2.
Efficacy of Different Antihypertensive Drug Combinations
- Different combinations of antihypertensive therapy, such as lisinopril, losartan, or valsartan alone or in combination with hydrochlorothiazide, are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension 4.
- The combination of amlodipine and lisinopril has been shown to be effective and safe in hypertensive patients, with significant reductions in blood pressure and improvement in ejection fraction 5.
Considerations for Administration
- The clinical pharmacology of antihypertensive drugs should be taken into account when choosing the correct dosages to ensure effective and homogeneous 24-hour blood pressure reduction 6.
- The potency of the drug, the degree of blood pressure reduction required, and the duration of action of the drug should be considered when prescribing antihypertensive medications 6.