Blood Pressure Medication Timing

What We Do In The Shadows

I've had messages from some of you about this already as I saw the article talking about how taking blood pressure medication at night might be more beneficial.

You can read more about it here, but the short story is that if you take blood pressure medications, taking them at night instead of in the morning.

It's tough to say exactly why this is as there are competing theories about how your body operates at night. I'd always heard that while these medications are supposed to last for 24 hours, there probably is some wiggle room as to how long they really do last, so they could wear off a few hours before your next dose is due. We've found in some other recent trials that nighttime blood pressure is a very important indicator of long term risk of heart disease too.

I think this is a good idea for most people to take their blood pressure medication at night provided a few things

- you can remember to take it every day (many people do not do that for nighttime medications I've found just because your routine at night tends to be less well defined than the morning routine)

- you're not taking a diuretic medication like hydrochlorothiazide or furosemide or chlorthalidone that causes you to urinate more frequently as I'm guessing any benefit is negated if you are getting your sleep more frequently interrupted.

I think I most commonly prescribe lisinopril, losartan and amlodipine for most people and these are all safe to take at night with minimal fear of side effects.

One thing I would say as well is that many men will take a prostate medication like Hytrin (terazosin) or Flomax (tamsulosin) - these are blood pressure medications already, albeit not great ones, but have a tendency to lower your blood pressure a lot already.

Multivitamins

If you can get the lid off, you probably don't need them When I ask people if they are taking any vitamins, herbs or supplements, many people will say they are taking a multivitamin. When I ask them why they take it, I get a quizzical look most of the time. I think this is something that resonates from childhood and parental advice of the idea that we need vitamins to help our body develop. I'm not pediatrician so I can't speak to the effects on the developing child, but I will say that most non-pregnant adults without major medical conditions do not need extra vitamins. You'll be impressed by these labels promising 120%, 300%, 1200% of your daily dose of vitamin whatever it is, but the truth is that for most of these vitamins, if you take more than your daily dose your body needs, the rest just ends up in your urine. You are literally peeing money away in this case. There's been a new trendy vitamin every decade or so for the last 40-50 years; First it...

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen). Those are the over-the-counter ones. Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on. All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation. However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock. every other organ system that you have. The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance. Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child. For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was. Fortunately, there were researchers who had a yen to poke peopl...

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