Bedtime Dosing of Blood Pressure Medications

(Pharmacist's Letter: January 2012; Vol: 28, No. 1)
Todd Harris RPh, CGP Director of Consulting

More and more facilities begin to move towards patient centered care and flexible medication administration times, we occasionally get asked "When is the best time of day to give blood pressure medications?"

Most of our residents receive all their once-daily medications in the morning. There is new evidence that suggests that giving at least one blood pressure medication at bedtime improves BP control and therefore decreases cardiovascular events in some patients. Researchers suspect that bedtime dosing may be especially useful for patients whose blood pressure doesn't "dip" at night like it should. These patients are generally older or have diabetes, kidney disease or resistant hypertension. However, lowering the BP too much at night can lead to nocturnal hypotension and possibly orthostatic hypotension and falls. These adverse effects need to be monitored and adjustments made as  necessary. In general, it is recommended that those residents taking just one or two once-daily BP meds take them in the morning, especially if they are receiving a diuretic.

If they are taking three or more BP meds it may be benefi cial to give one of the once-daily mediations at bedtime, especially if the BP is consistently high in the morning or drops too low during the day. If you think a resident may be a candidate for a bedtime BP medication, ask your consultant pharmacist to review the resident's medications and if appropriate make a recommendation to the attending physician.

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