The night is a delicate phase of the day, in which the activity of the renin angiotensin – aldosterone system, responsible for blood pressure control, occurs.
I am hypertensive and would like to know if it is better to take the lozenge in the morning or in the evening, so that it is more effective in keeping my blood pressure under control and preventing the risk of heart attack or stroke.
He answers
Marina Food
Scompenso operating unit, clinical and rehabilitation cardiology, Monzino Cardiology Center, Milan (GO TO THE FORUM)
We all know that we must treat thehypertension per reduce the risk of being affected by the so-called cerebro-vascular accidents: myocardial infarction, stroke and vascular disease. The very interesting question, in fact lat night a delicate phase of the day
, in which the activity peak of the renin angiotensin – aldosterone system, responsible for blood pressure control, occurs. Furthermore, the early hours of the morning are characterized byincreased alpha adrenergic activity, resulting in increased blood pressure, increased platelet aggregation and reduced fibrinolytic activity. All these mechanisms justify the prevalence of cardiovascular events which occurs precisely at night. Based on these observations, several scientific studies have been carried out in recent years. The trial was published in 2020 Hygia Chronotherapy which proved that
the intake of drugs in the evening, compared to the morning one, has a more protective effect
against cardiovascular events.
The population was followed for ten years and the choice of drugs was not standardized, but depended on the choices of the individual Centers or individual health professionals. This made comparison between the various groups more difficult. The results were not confirmed by subsequent studies. At the European Congress of Cardiology (ESC), which took place in Barcelona in August, the data of the study were presented Time; a large prospective work conducted on 21,100 patients, randomized into two drug therapy groups, with a 1: 1 ratio, in the morning or in the evening. The mean follow-up was 5.2 years, but some subjects were followed for more than 9 years. This study did not show statistically significant differences in terms of prevention and hospitalization for non-fatal myocardial infarction, non-fatal stroke or vascular death, comparing the evening administration group with the morning administration group. According to the results of the study Timetherefore, non resultsIt is dangerous to maintain current habits in the administration (preferably in the morning) of antihypertensive therapy.
Obviously, to enter into the specific case of individual patients, it is not enough to rely on scientific literature. These studies are an aid to the physician trying to choose the best therapy for the individual patient. However, in clinical practice, we know that we do not always manage to use a monopill for the hypertensive patientalthough the pharmaceutical companies help us in this sense with the pre-established associations of several molecules.
There are in fact patients for whom the hypertensive state is more severe and requires the use of 4-5 drugs a day; in these cases at least two times of administration are recommended, generally morning and evening. Other frail elderly patients may be better treated by splitting into small multi-daily doses therapy, to avoid too sudden drops in blood pressure.
October 16, 2022 (change October 16, 2022 | 10:54)
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