Poster Gerald1967 linked to this NCBI listed article (2014) which talks about BP and natural (vs. pharma) BP control approaches. Interesting read generally, but this popped out. The journo writes it as if it's a known fact. It likely is a known fact, but just not a fact known by your typical patient or even your typical doctor.
It concerns the time of day you take your BP medication. The first sentence to start with, but do read on...
"(Cardio)Event rates are strongly affected by timing of treatment administration; they are 25% to 50% lower when a drug is given at night. Also, most drugs may partially convert nondippers to dippers if dosed nocturnally. The drugs that will not convert nondippers are those recommended, Dr. Houston emphasized, by JNC reports 1 through 8: thiazide diuretics (hydrochlorothiazide), thiazide-like diuretics (chlorthalidone), and the older beta blockers like metoprolol and most other “ols.” The ones that will convert nondippers are ACEIs, ARBs, most CCBs, and perhaps one or two newer beta blockers (nebivolol and carvedilol)."
ncbi.nlm.nih.gov/pmc/articl...
I take my ACE in the morning!! Who takes theirs at night?
What's this dipper business?
Reading a bit further into it today. To dip or not to dip, that is the question. In fact it's a question that's already been answered.
academic.oup.com/eurheartj/...
It is healthy and normal for your BP to dip during the night. A 10-20% drop in mean daytime BP is the healthy range. Less dipping that this is associated with bad outcomes. If you're outside the range (i.e. you're a <10% dipper), then the less you "dip" the worse it gets for cardio events like heart failure and strokes.
Now guess which is one of the cohorts who frequently belongs to the "non-dippers" club. Yup, its us lot again, the CKD-ers. If I have it right, the CKD causes you to be a non-dipper rather than the other way around. It's just another of the innumerable consequences of impaired kidney function. Just another reason why we'll typically die of a cardiovascular incidents rather than ever get to that comparative Nirvana called "dialysis or transplant"
Question as an aside: how many of you here have had their doctor check whether they are dippers or no? A 24hr BP test is the way to find out apparently. I arrived at the above cited paper whilst looking into Aktiia cuffless wearable BP monitors. A fresh off the press new tech which allows you to track your BP with 24hr coverage.
{EDIT} I've since explored the Aktiia 24hr cuffless BP monitor. It turns out to be a bit of a disappointment. The unit has no way of compensating for the fact that your wrist might be well below or well above your heart - and so readings will be well off. Their own "evidence" says that the unit is capable of recording an accurate BP between 25 and 67% of the time. Which is useless. {/EDIT}
From the above cited paper.
"Several studies have shown the benefits of bedtime administration of antihypertensive medications in various patient populations."
"Wang et al.14 in a meta-analysis comprising 3732 patients observed that bedtime administration of medications was effective in lowering blood pressure in non-dippers among chronic kidney disease patients."
"The study reported by Hermida et al.18 in this issue of the European Heart Journal is a multicentre prospective, open-label trial in almost 20 000 hypertensive patients in a primary care setting, making it one of the most extensive studies of its kind. Patients were asked to take their antihypertensive medications either at bedtime or soon after awakening. This trial had a good representation of all age groups and both genders. Additionally, ambulatory blood pressure was monitored for 48 h and, the patient follow-up was quite long, i.e. 6.3 years. The most remarkable result noted in this trial was a 45% reduction in cardiovascular events with ingestion of the entire daily dose of blood pressure-lowering medications at bedtime compared with the morning intake. The bedtime administration of blood pressure medications was also associated with improved renal function, lower prevalence of non-dippers, lower LDL-cholesterol, and higher HDL-cholesterol. "
That's some significant result, that last para. In fact, when you go to Hermida trial paper they are referring to above, you find this this:
"Beyond more effective ABP control, the bedtime therapeutic strategy was also associated with improved renal function—significantly lower serum creatinine and albumin/creatinine ratio with higher eGFR—and favourable redistribution of lipid profile—significantly lower LDL cholesterol and higher HDL cholesterol—(Table 2), all of which are well-recognized relevant biomarkers of CVD risk."
academic.oup.com/eurheartj/...
The "table 2" referred to above has some interesting stuff on the renal function of the participants taking meds at bedtime vs awakening. The participants haven't necessarily got CKD (although some have), but they do have hypertension:
eGFR 79.3 (at bedtime) vs 75,7 (on awakening)
Creatinine 1.06 vs 1.16
ACR 6.5 vs 7.0
That's not a bad result for simply shifting the time of day you take your BP meds at!!
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Probably worth digging more into this. I wonder how that other ACE benefit: reduction in proteinuria .. would be impacted by shifting ACE meds intake to bedtime. You don't do most of your kidney filtering work at night I guess, so it could be that your proteinuria would go up during the day?
