New research has shown that the best time to take high blood pressure tablets is before bed. 

A large-scale study conducted across GP surgeries in northern Spain found that people who took their blood pressure medication before bed were up to 45% less likely to experience a heart attack, heart failure, stroke or cardiovascular disease.

The study consisted of approximately 20,000 adults with high blood pressure. Half of the participants were instructed to take blood pressure treatment at bedtime, while the other half were advised to take it upon waking. They were followed up for a period of 6 years, on average. 

What specific findings did the study make? 

Having accounted for age, sex, smoking, history of cardiovascular complications and a natural decrease in blood pressure during sleep, the research team discovered that participants who used blood pressure medication at night-time were 56% less likely to die from cardiovascular disease, 49% less likely to experience stroke and 44% less likely to have a heart attack, in comparison with the group who took treatment upon waking.     

Not only does taking blood pressure treatment before bed reduce serious risk factors, it bolsters blood pressure control. Participants had better sleeping blood pressure profiles and lipid profiles in the randomised trial. 

When does blood pressure tend to rise and fall?

In the majority of cases, blood pressure starts to rise shortly before getting up in the morning, and peaks around 12pm. It then declines during sleep, and hits its lowest point between midnight and 3am to 4am.

People with high blood pressure however tend to have only a small to zero decrease in their blood pressure at night-time. It therefore follows that, in taking blood pressure medication at night, the treatment can tackle these elevated levels.

Using blood pressure treatment in the morning, rather than at night, has previously been the  more popular recommendation amongst doctors, on the premise that the medication will interrupt the rise in blood pressure through the morning. 

Previous research has suggested that improved blood pressure control at night could be advantageous, but the trial conducted in Spain, on a much larger, randomised scale, has helped to consolidate this theory more. 

Should I change my routine for taking blood pressure medication, then?

In spite of the promise offered by the study however, researchers advise patients to consult their doctors before altering their routine for blood pressure treatment. 

It should also be noted that diuretics (water tablets) are a form of blood pressure medication that increase your need to urinate during the night. If you use this treatment, discuss with your GP as to the best routine for you. 

Page last reviewed:  14/02/2020