Best time to take blood pressure medicine losartan

Research has suggested that taking your blood pressure medication at night instead of in the morning can provide better blood pressure control at night without compromising daytime blood pressure control and reduce your overall risk of dying because of cardiovascular disease by 45%.

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Should losartan be taken in morning or night?
Why is losartan taken at bedtime?
Is it better to take blood pressure medication at night or in the morning?
What should I avoid while taking losartan?

The reason taking blood pressure medication at night may be more effective is explained by the concept of chronotherapy, which considers the circadian rhythms of patients to improve their response to medications. Circadian rhythms are bodily processes that respond to light and dark and follow a 24-hour cycle. Blood pressure in people who DO NOT HAVE high blood pressure rises and falls in a predictable pattern. When people wake in the morning, blood pressure surges and then increases throughout the day. At night during sleep, it tends to drop again, by about 10% to 20%. But blood pressure can behave differently for some people with HIGH blood pressure, and four distinct patterns are recognized:

Those that experience a normal drop in blood pressure of 10% to 20% (normal dipping)
Those who experience extreme dipping – a drop of more than 20%
Those who hardly dip at all (non-dipping), which is a drop of less than 10%
And those who experience reverse dipping – where their blood pressure is higher during sleep than while they are awake.

The only way to know if your blood pressure changes at night is to wear an ambulatory blood pressure monitoring device for 24 to 48 hours and measure your blood pressure regularly throughout the day. Ask your doctor about this.

Studies have shown that people who experience non-dipping, reverse dipping, or extreme dipping have a higher risk of cardiovascular disease events than those who experience normal dipping, and these people may benefit from taking their blood pressure medications at night because it normalizes their blood pressure. People over the age of 55 are more prone to non-dipping.

The Hygria chronotherapy trial followed 19,084 Caucasian Spaniards with high blood pressure for an average of 6 years. Half the group took their blood pressure at bedtime while the other half took it in the morning. People who took their blood pressure medication at night had overall better blood pressure control and were less likely to have a cardiovascular event, such as a heart attack or stroke.

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Losartan can be taken once or twice a day. For once daily dosing, there are no absolute recommendations about taking it in the morning vs. night. For high blood pressure, some research suggests taking medicines at night reduces the risk of cardiovascular events in the morning. Check with your doctor for questions about timing.

WEDNESDAY, Oct. 23, 2019 (HealthDay News) -- Taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure, a large, new study finds.

Researchers in Spain followed more than 19,000 adults with high blood pressure. They found that people who took all their blood pressure meds at night had lower blood pressure around the clock compared to volunteers who took their medication in the morning.

"The findings are highly consistent regardless of sex, age, presence of diabetes or kidney disease, and other major known factors of increased risk," said study lead author Ramon Hermida.

Hermida is director of bioengineering and chronobiology at the University of Vigo's Atlantic Research Center for Information and Communication Technologies.

"Conventionally, most patients ingest their medication in the morning," said Hermida, "although no single trial ever documented this to be preferable." No guidelines are currently in place regarding the best time to take the drugs, he added.

A New York City heart doctor believes consistency in taking your blood pressure pills will deliver optimal protection.

"The key here is routines," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital. "Not missing a dose. We know one thing worse than an elevated blood pressure is swings in blood pressure due to periodic non-compliance."

To achieve compliance, it's important to stick to a routine, Bhusri said.

Besides compliance, factors such as emotions and simultaneous use of other medications can affect a drug's effectiveness, Bhusri noted.

The investigation -- called the Hygia Chronotherapy Trial -- ran between 2008 and 2018. It involved about 10,600 men and 8,500 women in northern Spain, aged 18 and older.

All had been diagnosed with high blood pressure prior to the study. The patients were tracked for a little over six years on average.

Study participants were randomly assigned to take all of their blood pressure pills just once a day, either in the morning or at bedtime.

Blood pressure was repeatedly assessed throughout the study. At least once a year, participants also wore a mobile monitor, which logged multiple blood pressure readings over two days.

In the end, the investigators found that those who always took their meds at night saw their risk of dying as a result of heart or blood vessel problems plunge by two-thirds, compared with those who always took them in the morning.

A bedtime drug regimen was also linked to a 44% drop in heart attack risk; a 40% drop in the risk for surgery to widen arterial pathways (coronary revascularization); a 42% lower risk for heart failure; and a 49% dip in stroke risk, the researchers reported.

Overall, the reduction in risk for cardiovascular-related death was 45%, the findings showed.

Why? Because of better nighttime blood pressure control, Hermida said.

"We have previously documented that asleep blood pressure is the most significant marker of cardiovascular risk," he explained. This is true whether daytime measurements taken at the doctor's office are normal or elevated.

The yearly 48-hour mobile blood pressure readings showed that patients who took their meds at night had "significantly reduced" blood pressure while asleep, compared with their peers who followed a morning medication routine.

Hermida did acknowledge a few caveats. For one, all study participants had to follow a typical sleep routine: up during the day and asleep at night. That means the study cannot speak to how medication routines might affect individuals who habitually work at night.

Also, all of the participants were white. Hermida said follow-up studies must be racially mixed. He pointed out that black Americans tend to have a higher-than-average blood pressure rate while asleep, so future research will need to focus on how medication timing affects them in particular.

Even so, he hopes the study findings may finally give clinicians some guidance when instructing blood pressure patients on best practices.

Bhusri added that patients should speak with their doctor before changing the timing of their medication.

The study results were published online Oct. 22 in the European Heart Journal.

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SOURCES: Ramon C. Hermida, Ph.D., FASH, FAHA, director, bioengineering and chronobiology labs, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain; Satjit Bhusri, M.D., cardiologist, Lenox Hill Hospital, New York City; Oct. 22, 2019,European Heart Journal, online

Should losartan be taken in morning or night?

What Pharmacists Say About When to Take Your Losartan (Plus 4 Other Tips) Key takeaways: Losartan (Cozaar) is an angiotensin II receptor blocker used to treat high blood pressure. The best time for many people to take losartan is in the morning.

Why is losartan taken at bedtime?

Is it better to take blood pressure medication at night or in the morning?

What should I avoid while taking losartan?

Losartan has caused significant increases in blood potassium levels. Potassium supplements, potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others), and even high-potassium foods (including Noni juice) should be avoided by those taking losartan, unless directed otherwise by their doctor.