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.

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...

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before. For women who have had children, they generally know what a 10 is, but for men it's a little harder. When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?" The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth. The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...

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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