Posted October 25, 2011, 2:48 pm , Updated April 16, 2020, 12:00 am. [Circadian rhythm of arterial pressure and use of amlodipine in primary hypertension]. This site needs JavaScript to work properly. Slightly off topic, but perhaps still in the same general category of simple steps that might reduce BP (and hopefully risk of adverse outcomes), I wonder if TSK would comment on this. I don’t use loop diuretics (like furosemide for hypertension which maintain their potent diuretic effect over time. Epub 2013 Feb 27. I’m already taking Ramipril at 5pm so that’s easy to move to bedtime. One must wonder what is the cause for this improvement in results? Surprising but real result! The phase IV clinical study is created by eHealthMe based on reports of 6,009 people who take Amlodipine and Crestor from the FDA, and is updated regularly. . Amlodipine treatment had no effect on heart rate. The waking BP measurement will now be augmented by a bedtime check as well. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. I wonder what TSC thinks of replacing essentially all added dietary table salt (sodium chloride) with powdered potassium chloride, such as in this product: https://www.swansonvitamins.com/now-foods-potassium-chloride-powder-8-oz-pwdr. New research suggests that taking your blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease. Blood Press Monit. https://www.ncbi.nlm.nih.gov/pubmed/25016398, https://www.ncbi.nlm.nih.gov/pubmed/26039623, https://www.ncbi.nlm.nih.gov/pubmed/30125063, https://www.ncbi.nlm.nih.gov/pubmed/28678188. Does that make sense? Did the trial data separate between types of BP meds and their relative effect to dosing period? Great questions which I have pondered extensively. I will be putting all my B P pills in the bedtime slot from now on. Kaur G, Phillips CL, Wong K, McLachlan AJ, Saini B. Pharmaceutics. It’s best to consult with your provider and inquire why they have prescribed to take in the morning or before going to bed. Interactions. 2000 Aug;24(4):280-90. doi: 10.1053/sper.2000.8595. Here is a link to a Mayo Clinic page on pulse pressure, https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/pulse-pressure/faq-20058189. This study doesn’t answer that question. . Howard LeWine, M.D. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. This being said, for those who don’t do slope running and rely on medications, this well-done study suggest bedtime is the time to dose up. Regular physical activity can also help lower blood pressure and keep your weight at a healthy level. For many years, there have been at least three theoretical reasons for taking blood pressure medicines before bedtime. Opening the Debate: How to Fulfill the Need for Physicians' Training in Circadian-Related Topics in a Full Medical School Curriculum. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Amlodipine is also used to treat high blood pressure. Patients are too often taking PPIs in the morning and not eating breakfast or taking their drug before bed on an empty stomach. Beta brain fog is a common issue, and improvements with bedtime dosing are an added benefit. I’m also taking 5mg Amlodipine in the AM and Metaprolol 25mg twice a day. This study is practice-changing for me. https://www.ncbi.nlm.nih.gov/pubmed/26039623. Thanks Would you like email updates of new search results? Be sure to leave out the booze because booze will most like negate the benefit of taking BP medications just before going to bed. The so-called Hygia Chronotherapy Trial was extremely well done and the results are powerful and should modify clinical practice immediately. This was not looked at in the Hygia study, apparently not considered to be an important variable… “To everything there is a season, and a time to every purpose under heaven.”. Omega-3 Fatty Acids and Cardiovascular Disease Risk: Has the Story Ended or Only Just Begun? If the benefit to bedtime prescribing is real, that may be why." In my case, there is a nearby mountain with just the right slope. A quick search on Pubmed now pointed me to several abstracts: https://www.ncbi.nlm.nih.gov/pubmed/25016398 Increased potassium intake can be achieved either by augmenting dietary potassium intake or by use of potassium supplements. For years! Erwin I have to wonder why you write this about “booze negating the benefit of taking BP medications just before going to bed.” I just love my cardiologist! OBJECTIVE: To determine the antihypertensive efficacy and the potential impact on circadian blood pressure pattern of morning versus evening administration of amlodipine to essential hypertensive patients. Drug interactions are reported among people who take Amlodipine and Crestor. The morning administration of a valsartan/amlodipine combination showed noninferiority to the bedtime administration in the change of nocturnal brachial and central SBP in …  |  I, however, wouldn’t take a diuretic such as lasix before bed. Can I take both the medicines twice daily? RESULTS: Both morning and evening administrations of amlodipine significantly (P < 0.01) reduced the elevated systolic and diastolic blood pressures during daytime. They all tend to have a peak BP lowering effect some time after ingestion and before 12 hours which corresponds to the peak levels in the blood. Curr Hypertens Rep. 2018 May 5;20(5):43. doi: 10.1007/s11906-018-0843-5. Note that stroke rate was halved! METHODS: Twelve mild-to-moderate essential hypertensives were investigated in this open, randomized cross-over study. USA.gov. I tried this some time back and though I did not track my BP (it is fairly low to start with, so I don’t worry about it much), I did notice a reduction in my tendency toward palpitations (probably PVCs associated with a baseline slow pulse rate). What I suspect you have, rather, is a sinusoidal concentration pattern, with the fluctuations all (hopefully) remaining within a therapeutic range, never going above the maximum safe level or below the minimum effective level–but that range might be pretty wide and I’d suspect that there could be some variation in efficacy between the high and low levels. I also had brain fog and symptoms of depression under atenolol. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Does Amlodipine Cause Swelling. I really really like that medication… As a mostly ß1-blocker (at doses lower than 10 mg/day), it does not slow down the heart as much, and works by enhancing peripheral vasodilation and cardiac output. Chronobiological analysis of blood pressure in a patient with atrial fibrillation at the development of heart failure and its therapeutic and surgical treatment. How long does it take for Norvasc to work? Lovastatin should be taken with dinner. Medication for high blood pressure is more effective when taken at bedtime than the following morning. The drug-induced decrase in the early morning rise in blood pressure may be advantageous in reducing the early morning cardiovascular risk. Although a 2006 Cochrane review concluded there was insufficient evidence to recommend potassium supplementation in the treatment of hypertension more recent meta-analyses suggest a modest effect (5 mm Hg drop in systolic). What might this suggest for those who take multiple meds at different times of day – say HCTZ with breakfast, Amlodapine with dinner and Losartan at bedtime? Indeed, the bedtime administration of nifedipine gastrointestinal therapeutic system was associated with a 93% reduction in oedema compared with morning dosing (1% vs 13%, p<0.001, respectively). I take 2 different blood pressure medications (Ramipril + Amlodipine 10mg) and didn't enjoy the general tiredness during the day from taking them early in the morning. h/t Reader Lee Sacry for bringing this study to my attention, The skeptical cardiologist has just updated his page on atrial fibrillation. The Role of Circadian Rhythms in the Hypertension of Diabetes Mellitus and the Metabolic Syndrome. Relevance for chronopharmacology in practical medicine. You can slope run using an incline treadmill with up to a 30% gradient. 4 Other reported side effects include dizziness, fatigue, headache, palpitations and nausea, although these are generally not bothersome enough to cause discontinuation of the drug. Is it a reason why Indapamine is not prescribe in USA instead of HCTZ. Bowles NP, Thosar SS, Herzig MX, Shea SA. It actually does make sense — based on recent research. Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi: 10.1007/s11906-018-0897-4. Pulse pressure, the difference between systolic and diastolic pressure, is also a helpful metric. For example, there is a long acting form of metoprolol. I sure do hope not! Knowing the best time to take such drugs … We also don’t know it taking at bedtime (as was done in this study) is better than say after dinner. NLM The early morning rise in blood pressure was decreaseed after morning and slightly more pronounced aftger evening dosing of amlodipine. Please enable it to take advantage of the complete set of features! However, the potential differing effects on BP of amlodipine given at different times of the day have only been addressed occasionally. I’d love to know the answer but pending having that information I’m going with shooting for lower BP goals when we are utilizing the SPRINT type #s in our measurement. Thanks to my cardiologist. We will be advising all hypertensive patients to take their once daily BP meds at bedtime. Bedtime Administration of Amlodipine Versus Lisinopril (BAVLART) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. I think a likely mechanism is the (mentioned) enhancement of the dipping phenomena. Amlodipine works by relaxing the blood vessels (arteries) that carry blood away from the heart to the rest of the body, causing less resistance to blood flowing in your arteries. I have a post in the works on nebivolol (bystolic) and I may have mentioned it in a prior post on beta blockers and feeling logy. The following information includes only the average doses of this medicine. The early morning rise in blood pressure was decreaseed after morning and slightly more pronounced aftger evening dosing of amlodipine. But what about those of us who rarely are in this complete resting state. Extended-release nisoldipine versus amlodipine as a model. Chief Medical Editor, Harvard Health Publishing. Anthony C. Pearson, MD, FACC is a cardiologist focused on debunking cardiovascular myths and identifying best methods for utilizing lifestyle medications and procedures to promote cardiovascular health.If you are a potential patient and found this page through a Google search, please check out Dr. Pearson’s biographical information, disclaimers regarding his writings, and notice to patients here. I just took my BP at 6:10 mountain time using the EVOLV Omron cuff after slope running for 48 minutes today starting at 9:05 AM. After about 7 days of taking the med once per day at the same hour, regardless of the time of day taken, the concentration in the bloodstream will be at steady state. I’m not an expert in this, but my assumption is that there actually never is a true steady state. Sorry — I meant TSC — The Skeptical Cardiologist. Let me explain, it is easier for you to remember to take amlodipine tabs at that time because of the routine, it’s that simple! Punzi HA, Noveck R, Weiss RJ, Graf R, Ruff DA, Hutchinson HG, White WB. Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. We will be smart and take the med at bedtime. 2016 Apr 15;8(2):13. doi: 10.3390/pharmaceutics8020013. Studies show that when simvastatin is taken at night, there’s a greater reduction in LDL cholesterol than when it’s taken in the morning. Atrial Fibrillation Page Updated: New Questions on Exercise, Ablation, and Medications Answered, Tofu, Cheerios, Smoothies, Coffee Creamer, Sugar as Toxin: Avoiding Added Sugar, Fructose and Stealth Sugar, Hypertension (High Blood Pressure): Goals, Home Monitoring, Measurement Technique and Devices. Medicines that interact with amlodipine may either decrease its effect, affect how long … I take Amlodipine once daily and Atenolol twice daily. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. When should you take your once daily BP meds? It’s definitely got the least side effects of the beta blockers. Bystolic is not generic! Might that achieve some of the benefits mentioned above? https://www.ncbi.nlm.nih.gov/pubmed/26039623 So why does the pm administration change things? 1 Your doctor may occasionally change your dose to make sure you get the best results. Thank you both for sharing your personal experiences with nevbivolol – will discuss this with cardiologist next visit. Amlodipine treatment had no effect on heart rate. CONCLUSION: The results demonstrate that, independently from the dosing time, the long-acting calcium antagonist amlodipine sufficiently reduced blood pressure in essential hypertensive patients without increasing the nightly drop. J Circadian Rhythms. Now a study published in European Heart Journal in October has demonstrated that routine ingestion of BP meds at bedtime as opposed to waking results in improved 24 hour BP control with enhanced decrease in asleep BP and increased sleep-time relative BP decline (known as BP dipping. I keep track of my pulse pressure, and it falls, along with the systolic and diastolic measurements with increase in exercise. This figure demonstrates the dramatic and highly significant 45% reduction in all types of cardiovascular events measured. BP is 97/57 and RHR 55 BPM. More importantly, bedtime BP med ingestion in this randomized trial of over 19 thousand hypertensive … Kardia band on Apple Watch for EKGs, and Omron HEM 7280T for BP. However: this is a very strong study: large cohort, prospective, long followup, smart, real-life endpoints… Very impressive. Amlodipine may be … So I switched briefly to taking them before bed and I'd wake up in the morning feeling like I hadn't slept a minute. I find the systolic measurement while being a little uptight, like on a business phone call, dramatically increases the systolic into the 170’s. I’ll go read that post now. Increasingly, the skeptical cardiologist has been recommending to patients that they take BP meds at bedtime as evidence has mounted  that this does a better job of normalizing asleep blood pressure and minimizing daytime side effects. 2013;2013:490705. doi: 10.1155/2013/490705. If your dose is different, do not change it unless your doctor tells you to do so.The amount of medicine that you take depends on the strength of the medicine. A bunch of pills of mine just switched location today… Would the diuretic cause the person to wake up and have to urinate in the middle of the night? https://www.ncbi.nlm.nih.gov/pubmed/30125063 Patients who don’t dip are at significantly higher risk stroke and MI than nondippers. Thanks for that! consider switching to chlorthalidone bexy. So overall I feel the benefits of no alcohol are worthwhile. The apparent circadian rhythm of cholesterol production sparked the recommendation that statins be dosed at bedtime to provide the greatest medication concentration when endogenous cholesterol production is the highest. If you wish to try it at night to see if it changes your tired feeling, that should not hurt anything. I just really enjoy a little scotch in the evening, or 1-2 glasses of wine with supper. The main reason why you would want to switch to night time, or before bed dosing, is for side effect avoidance. Now a study published in European Heart Journa l in October has demonstrated that routine ingestion of BP meds at bedtime as opposed to waking results in improved 24 hour BP control with enhanced decrease in asleep BP and increased sleep-time relative BP decline (known as BP dipping.) Recently, my doctor recommended taking them at bedtime, instead. For some patients I also have them take metoprolol succinate twice daily. COVID-19 is an emerging, rapidly evolving situation. A recent JACC review of treatment of hypertension had this to say “Increasing potassium intake lowers BP in hypertensive adults (46–50), especially among those who are black, older, or consuming a high intake of dietary sodium (51). Effects were evaluated by linear and rhythm analysis using the ABPM-FIT program. My wife takes three meds, one at breakfast, one at dinner and one at bedtime (Amlodapine, HCTZ, Losartin) How might this study apply to multiple med patients? Research has shown that, in people who are … Amlodipine: This drug is usually taken in the am but it can be taken at night. Do you know of any studies that would support your assertion? Here are the Kaplan-Meier curves showing early and progressive separation of the treatment curves. Common interactions include dizziness among females and chronic kidney disease among males. The MAPEC Study (Spanish: Monitorizacion Ambulatoria para Prediccion de Eventos Cardiovasculares; English: Ambulatory Blood Pressure Monitoring for Prediction of Cardiovascular Events) was designed to test the hypothesis that bedtime dosing of one or more antihypertensives not only provides better blood pressure control, but also allows for improved cardiovascular risk reduction. So I guess if you do have sleep apnea (as I do), treat it… but whatever: take your BP meds in the evening. I’m on it myself and I can’t wait until it goes generic and becomes less expensive for my patients. When I switched to nebivolol, the very clear and almost immediate result was that these symptoms just vanished. By then, had they not reached statistical significance sufficient that a safety-monitoring committee would have stopped that study? The diuretics that I use are thiazine diuretics and spironolactone which over time have very little immediate diuresis after being taken. There was no difference side effects or compliance between the two groups. Selfridge JM, Moyer K, Capelluto DG, Finkielstein CV. from my reading, it beats HCTZ in every way. The results are SO good that one wonders: why was this study not discontinued at the 5, or 6-year mark? Statins are cholesterol-lowering drugs. Amlodipine is used to treat chest pain (angina) and other conditions caused by coronary artery disease. Are we worse off? I take HCTZ in the morning to avoid waking at night. Are there differences in the effects of long-acting calcium antagonists on ambulatory blood pressure? On atenolol my HR would hardly go over 105-115… Maximal blood pressure values were significantly (P
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