why take amlodipine at bedtime
I take Amlodipine once daily and Atenolol twice daily. METHODS: Twelve mild-to-moderate essential hypertensives were investigated in this open, randomized cross-over study. 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 don’t know that this would cause any harm! It is well known that blood pressure medications can cause dizziness, sedation or even orthostatic hypotension (a significant drop in blood pressure when you go from a lying position to a standing position). 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. One must wonder what is the cause for this improvement in results? Medicines that interact with amlodipine may either decrease its effect, affect how long … 2016 Apr 15;8(2):13. doi: 10.3390/pharmaceutics8020013. I take HCTZ in the morning to avoid waking at night. 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. I’m not an expert in this, but my assumption is that there actually never is a true steady state. In my own situation no alcohol at all, from one glass of wine with evening meal, resulted in lowered BP, and PVCs and PACs incidence reduced significantly. Can I take both the medicines twice daily? Beta brain fog is a common issue, and improvements with bedtime dosing are an added benefit. Maximal blood pressure values were significantly (P = 0.01) decreased by both treatment regimens, whereas nightly minimum values remained unchanged. Chronobiological analysis of blood pressure in a patient with atrial fibrillation at the development of heart failure and its therapeutic and surgical treatment. Relevance for chronopharmacology in practical medicine. This study doesn’t answer that question. This was not looked at in the Hygia study, apparently not considered to be an important variable… I think a likely mechanism is the (mentioned) enhancement of the dipping phenomena. Amlodipine is also used to treat high blood pressure. [Circadian rhythm of arterial pressure and use of amlodipine in primary hypertension]. Chibisov S, Katinas G, Brodskaya I, Ertman A, Gromyko G, Konradi A, Mamontov O, Merkuryeva A, Polunicheva E, Shlyakhto E, Soboleva A, Yashin S, Bhavdip B. Cardiol Res Pract. Drug interactions are reported among people who take Amlodipine and Crestor. Statins are cholesterol-lowering drugs. Follow your doctor's orders or the directions on the label. Are there differences in the effects of long-acting calcium antagonists on ambulatory blood pressure? The so-called Hygia Chronotherapy Trial was extremely well done and the results are powerful and should modify clinical practice immediately. I keep track of my pulse pressure, and it falls, along with the systolic and diastolic measurements with increase in exercise. The morning administration of a valsartan/amlodipine combination showed noninferiority to the bedtime administration in the change of nocturnal brachial and central SBP in … https://www.ncbi.nlm.nih.gov/pubmed/30125063 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. h/t Reader Lee Sacry for bringing this study to my attention, The skeptical cardiologist has just updated his page on atrial fibrillation. I have also found potassium as a salt substitute is unpalatable. A. Because of its BP-lowering effects, increased potassium intake would be expected to prevent CVD events, and several studies have demonstrated an inverse relationship of potassium intake to stroke as well as other forms of CVD (52). Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi: 10.1007/s11906-018-0897-4. I was quite surprised because as an older man, one just gets to believe that being grumpy and even sometimes hostile just goes with age… my symptoms went unrecognized for a very long time. Do you know of any studies that would support your assertion? I also had brain fog and symptoms of depression under atenolol. Might that achieve some of the benefits mentioned above? 1998 Aug;3(4):267-272. 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. The results are SO good that one wonders: why was this study not discontinued at the 5, or 6-year mark? USA.gov. For many years, there have been at least three theoretical reasons for taking blood pressure medicines before bedtime. COVID-19 is an emerging, rapidly evolving situation. https://www.ncbi.nlm.nih.gov/pubmed/26039623. 2013;2013:490705. doi: 10.1155/2013/490705. Bystolic is not generic! Amlodipine is a calcium channel blocker that dilates blood vessels and improves blood flow. A bunch of pills of mine just switched location today… We will be advising all hypertensive patients to take their once daily BP meds at bedtime. This figure demonstrates the dramatic and highly significant 45% reduction in all types of cardiovascular events measured. . The waking BP measurement will now be augmented by a bedtime check as well. Would you like email updates of new search results? Regular physical activity can also help lower blood pressure and keep your weight at a healthy level. Would it be better to take that at bedtime than to take tartrate twice dailly? When I updated my BP page I went with the instructions utilized by major studies like SPRINT and which yield lower average BPs. So overall I feel the benefits of no alcohol are worthwhile. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. Epub 2013 Feb 27. “To everything there is a season, and a time to every purpose under heaven.”. My take on the data has been that increased potassium goes along with eating more healthy things-vegetables and fruit so I encourage that as opposed to taking supplements. 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/. 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. Kaur G, Phillips CL, Wong K, McLachlan AJ, Saini B. Pharmaceutics. We will be smart and take the med at bedtime. There was no difference side effects or compliance between the two groups. "Taking the medication at night preferentially lowers bedtime blood pressure and creates a more normal rhythm. Semin Perinatol. Amlodipine, a calcium antagonist of the 1,4-dihydropyridine type, has been shown to be effective in reducing blood pressure (BP) throughout the day and night when given once daily. I’ve updated the sections on medical management of AF and on AF ablation and, The skeptical cardiologist recently gave a virtual presentation for the Saint Louis University School of Medicine Grand Rounds which was an update on recent studies. Patients are too often taking PPIs in the morning and not eating breakfast or taking their drug before bed on an empty stomach. But what about those of us who rarely are in this complete resting state. This study is practice-changing for me. 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. Timing of Administration: For Commonly-Prescribed Medicines in Australia. However: this is a very strong study: large cohort, prospective, long followup, smart, real-life endpoints… Very impressive. Recently, my doctor recommended taking them at bedtime, instead. 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. 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. 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 love it for that, and also because my HR can increase more when I exercise: 135/min this afternoon while running my (almost) daily 2.5 km. Yes , except the metoprolol is likely the tartrate form that is taken twice daily. | consider switching to chlorthalidone bexy. This is good to know,because my blood presión medication is a Thiazide. 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). I just really enjoy a little scotch in the evening, or 1-2 glasses of wine with supper. Patients in whom a bedtime … 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. Amlodipine is usually taken once daily. Bedtime: Patients who are non-responders to the initial 30 mg/day dose and in turn receive 60 mg/day dose or patients who want to avoid ADRs (e.g. 2000 Aug;24(4):280-90. doi: 10.1053/sper.2000.8595. On atenolol my HR would hardly go over 105-115… Sleeping very well, and waking BEABT (bright eyed and bushy tailed) meaning bright alert and enthusiastic for the coming day, with none of the beta brain fog that often happened when taking beta blocker in the morning. Lovastatin should be taken with dinner. I have encountered the suggestion that an important and often unrecognized dietary factor in hypertension is low potassium intake, or perhaps more specifically, a low ratio of dietary potassium to sodium. 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 … I sure do hope not! A quick search on Pubmed now pointed me to several abstracts: https://www.ncbi.nlm.nih.gov/pubmed/25016398 Would the lipid-lowering meds be okay to take at bedtime? It’s best to consult with your provider and inquire why they have prescribed to take in the morning or before going to bed. (I switched because I wanted more cardiac adaptability to exercise/running…). (3) Investigation of pharmacokinetic properties of individual statins disproved the need for all agents to be dosed at bedtime. https://www.ncbi.nlm.nih.gov/pubmed/28678188 However, the potential differing effects on BP of amlodipine given at different times of the day have only been addressed occasionally. NLM Posted October 25, 2011, 2:48 pm , Updated April 16, 2020, 12:00 am. 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? Howard LeWine, M.D. 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.) Some statins work best in the evening while others work just as well in the morning. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. 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. Be sure to leave out the booze because booze will most like negate the benefit of taking BP medications just before going to bed. Would the diuretic cause the person to wake up and have to urinate in the middle of the night? BP is 97/57 and RHR 55 BPM. I just love my cardiologist! How long does it take for Norvasc to work? NIH More importantly, bedtime BP med ingestion in this randomized trial of over 19 thousand hypertensive … The remarkable aspect of this intervention is that it costs nothing, introduces no new medications and has no increased side effects. Thanks Effects were evaluated by linear and rhythm analysis using the ABPM-FIT program. 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’m already taking Ramipril at 5pm so that’s easy to move to bedtime. Sorry — I meant TSC — The Skeptical Cardiologist. 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). Surprising but real result! It actually does make sense — based on recent research. Weight is a big factor in high blood pressure. This prospective chronotherapy trial will investigate the potential differing efficacy of ramipril in doses from 5 to 10 mg/day when administered, as a monotherapy either upon awakening from nighttime sleep or at bedtime, to diurnally active patients with grade 1 or 2 essential hypertension, who will be evaluated by 48-hour ABPM before and after pharmacologic intervention. Treatment of mild-to-moderate hypertension with calcium channel blockers: a multicentre comparison of once-daily nifedipine GITS with once-daily amlodipine. Why take amlodipine at bedtime? I’m inclined to recommend bedtime and adhere to how the drugs were administered in this very positive trial. Please enable it to take advantage of the complete set of features! J Circadian Rhythms. The dose of this medicine will be different for different patients. 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). Note that stroke rate was halved! Medication for high blood pressure is more effective when taken at bedtime than the following morning. I take amlodipine 2.5mg per day at night before going to sleep. 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! I wonder how slope running compares with blood pressure medications over say a 5 year period. In some cases, lifestyle changes can lower or eliminate the need for blood pressure medication. For someone taking the following meds, all dosed once a day, is there any reason all could not be taken at bedtime? 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. Bowles NP, Thosar SS, Herzig MX, Shea SA. 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. When should you take your once daily BP meds? Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. Kardia band on Apple Watch for EKGs, and Omron HEM 7280T for BP. In my case, there is a nearby mountain with just the right slope. … 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. Here are the Kaplan-Meier curves showing early and progressive separation of the treatment curves. 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. | For years! This site needs JavaScript to work properly. 2003;19(3):226-37. doi: 10.1185/030079903125001677. I tried for a few more days, but it didn't improve at all. | Blood pressure and heart rate were measured by use of ambulatory blood pressure monitoring after a wash-out period of 1 week and after treatment schedules with 5 mg amlodipine once a day either at 0800 h or at 2000 h for 3 weeks. All right. But the study does not look into this specific aspect of the question… RESULTS: Both morning and evening administrations of amlodipine significantly (P < 0.01) reduced the elevated systolic and diastolic blood pressures during daytime. Common interactions include dizziness among females and chronic kidney disease among males. For some patients I also have them take metoprolol succinate twice daily. I’ll go read that post now. Your doctor may occasionally change your dose to make sure you get the best results. "best time of day to take amlodipine night time or morning ..currentley taking it in morning but feeling awefull tired." And you ARE right! Interactions. I really enjoyed the findings and conclusions in this article. I wonder how much of the reduction is attributable to individuals who have sleep apnea. Great questions which I have pondered extensively.
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