August 24, 2012
Dear Mayo Clinic:
I was recently put on medication for high blood pressure. Does it matter what time I take it? I thought I was supposed to take it before I go to bed. But when I do, I'm up all night using the bathroom. Also, is this medication something I will have to take for life?
It usually is not necessary to take your blood pressure medication at night, unless your doctor has told you to do so. Whether or not you have to take the medication for the rest of your life depends on a variety of factors.
In some cases, lifestyle changes can lower or eliminate the need for blood pressure medication. What you eat and how much you exercise can help control blood pressure. Lowering the amount of salt in your diet and eating plenty of fruits and vegetables, along with whole grains and low-fat dairy foods, can have a positive effect. Regular physical activity can also help lower blood pressure and keep your weight at a healthy level. Weight is a big factor in high blood pressure. Research has shown that, in people who are overweight, lowering one's weight by just 10 percent can lower blood pressure.
Regarding the timing of when you take your medication, in the past many doctors did recommend taking blood pressure medication at night. That was based on the fact that heart attacks happen most often in the early morning. In theory, bringing blood pressure down during the night lowers the risk for a heart attack in the morning.
The reality does not match up with that theory for several reasons. First, blood pressure naturally tends to drop during the night in people who do not have high blood pressure, as well as in most people who do. That means there's typically not a critical need for medication to lower blood pressure during the overnight hours. Second, today's blood pressure medications last quite a while. In many cases, they only need to be taken once every 24 hours. When you take the medications during those 24 hours should not matter, as long as you take them at the same time every day.
Experiencing disturbed sleep when taking blood pressure medications before bedtime is a common issue. Diuretics are the most frequently prescribed blood pressure medications. They work by helping your kidneys get rid of extra salt and water. They are often quite effective in lowering blood pressure. But they can make you go to the bathroom more often, especially in the hours right after you take them. To avoid this problem, you may want to start taking your blood pressure medication in the morning.
How long you will need to take blood pressure medication is hard to predict. Once they start taking medication to lower blood pressure, some people do continue to take it for the rest of their lives. However, there are steps you can take that may reduce your need for blood pressure medication.
In addition to the diet and exercise changes mentioned above, if you choose to drink alcohol, limit the amount you drink. Women and anyone older than 65 should not have more than one alcoholic drink a day. Men younger than 65 should have no more than two drinks per day. Also, try to manage stress in healthy ways. Although stress by itself does not cause high blood pressure, having a lot of daily stress does make it more difficult to treat the condition.
These self-care steps may help bring your blood pressure down. If that happens, you may be able to take less of your medications or eventually stop taking blood pressure medication completely. Talk to your doctor about making lifestyle changes that can help. Do not make any changes in your blood pressure medication until you talk to your doctor.
— Michael Hogan, M.D., Nephrology and Hypertension, Mayo Clinic, Scottsdale, Ariz.