If your doctor has prescribed one or more hypertension medications for you, you’re likely wondering about the best time of day to take blood pressure medication. Should you take your blood pressure medication before or after breakfast? At night? Just before bed, or earlier?

As with many medical questions, there’s an easy answer and a more complicated one. The easy answer is that, in general, doctors recommend taking your blood pressure medications at bedtime. This often gives the most benefit while lowering the likelihood that you’ll suffer from unpleasant side effects. But “in general” doesn’t mean “always.”

The Real Answer is “As Directed”

Because most people with hypertension end up on multiple simultaneous medications to manage their blood pressure—not to mention other drugs for other conditions—it’s not always as easy as abiding by the most general rule of thumb. Drug interactions, side effects, and the method of action of different medications can all play a role in determining the best timing for taking each of your meds. If a medication needs to be taken with a meal or makes you restless, for example, then taking it at bedtime isn’t practical. Depending on your mix of medications, you could end up with variations on night, morning and bedtime.

To make sure that the timing of your drugs is optimized, talk to your doctor and pharmacist about all the drugs you take, and be sure to get clear instructions regarding each one. It’s absolutely critical that you take the medications exactly as prescribed. Remember that the purpose of the drugs is to protect you from the devastating long-term effects of high blood pressure. Taking them at the wrong time of day, taking them inconsistently, or not taking them at all makes you vulnerable to serious outcomes such as heart attack and stroke.

The Importance of Compliance

Unfortunately, the American Heart Association reports that between 50% and 80% of patients either don’t take their hypertension meds correctly or fail to take them at all. The medical term for taking medications as prescribed is called “compliance.” Compliance with a prescribed hypertension drug protocol is a powerful predictor of health outcomes.

When researchers examined data on 1.3 million older adults who were taking at least three hypertension drugs, they found that patients who started out in good health and were compliant at least 75% of the time were 44% less likely to die than similar patients who complied less than 25% of the time. Better compliance to the drug regimen was also associated with reduced death specifically due to cardiovascular disease. Even those starting out in poor health slashed their risk of death from any cause by a third if they took their blood-pressure drugs consistently as instructed.

Obviously, not taking your meds as prescribed can deprive you of their benefits. But it can also cause your doctor to misdiagnose you with a form of high blood pressure called resistant hypertension, which is stubborn blood pressure that remains in the hypertension range despite treatment with three or more medications. This could lead to unnecessary, uncomfortable, and expensive testing for underlying conditions that might explain the diagnosis. Or your doctor could abandon your current regime, which would have been successful if adhered to, in favor of new medications with different efficacy and side-effect profiles which may or may not be helpful. 

Causes of Non-Compliance

So why do people fail to take their medications as indicated? There are several reasons.

“I’m Feeling Fine”

Some people stop taking the drugs either because they don’t feel any different when on the medications and assume they aren’t working, or because their blood pressure has come down and the patient feels the drugs are no longer necessary. Both reasons are misguided. High blood pressure is often called “the silent killer” because it tends to have no noticeable symptoms. So you should not expect to feel any differently when a blood pressure medication starts working. The only way to know whether it’s taking effect is by measuring your blood pressure. And if it is working, as evidenced by readings on your home monitor or the device in your doctor’s office, you must continue taking it. Hypertension drugs do not cure the condition, they merely help you to manage it. To get your blood pressure down and keep it there, you must take your medications as directed as well as engaging in lifestyle changes such as adopting a low-sodium diet, managing stress, and exercising. If you stop your meds after hitting your blood pressure goal, it will climb back up again.

“I Keep Forgetting”

When the National Community Pharmacists Association (NCPA) surveyed patients, it found that the top reason why patients fail to take drugs as prescribed is that they forget to take them. If you tend to forget about your meds, there are a few ways to keep yourself on schedule. One is to take them at the same time every day. Once a regime is established, it becomes habit and hard to forget. Another is to purchase an inexpensive pill organizer and place the meds according to the day and time of day they’re to be taken.

“It’s Too Hard to Get Refills”

Another important driver of noncompliance reported by the NCPA is the difficulty of getting prescriptions refilled. There is no doubt that this becomes more and more challenging as the healthcare community increasingly expects patients to advocate for themselves and act more like consumers than patients. Yet it’s crucial that you refill your prescriptions so you can benefit from them. If you have trouble with this, talk to your pharmacist about automatic refills and prescription delivery services. Ask them to coordinate with your doctor to get all of your prescriptions refilled and delivered at the same time so you don’t have to keep running to the pharmacy. And don’t be afraid to ask for help from a family member, friend or neighbor. Most people understand the importance of medications and will be willing to help.

“It’s Too Confusing”

If you’re taking lots of medications, it’s easy to get mixed up and forget a dosage. Once you’ve established which combination of blood pressure drugs works for you, ask your doctor if it’s possible to streamline them into a single combination pill. If you’re feeling overwhelmed, ask your doctor for a complete list of your meds along with the times they should be taken. Turn that into a written schedule and keep it handy. You can also download a smartphone app that helps you keep track of your medications.

Plan taking your blood pressure medications better, and learn new methods of treating your hypertension by ordering a copy of Bottomline Personal’s Blood Pressure Solutions.

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