Morning everyone! 

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

Each week we are aiming to talk about something that is useful clinically to help you live a healthier and better life. 


The Silent Killer 


What do we call the “silent killer”? 

You probably guessed it. High blood pressure, or hypertension. This is so common among us. 

As our lives become more stressful, the more out of shape we get and the worse we sleep. Our blood pressure goes UP. 

When I first got out of medical school, anything under 140/90 was considered adequate and “ideal” was 120/80. Now we know it’s much lower than that. 

I watch mine get a little higher every year and I do everything I can to lower it. 

I prefer blood pressure to be around 115/75 or so. 

There was an interesting study that recently came out that advocated for night time dosing of blood pressure medications. It concluded that if you have to be on a blood pressure medication you should probably take it at night. 


If you’re on a blood pressure medication, when should you take it? 


I used to say during the day because that’s when everything is going on. That’s when you are most likely to be stressed. 

I’ve since changed my mind on this because these statistics from the aforementioned study are dumb founding to me. 

This study is called the Hygea Chrono Therapy trial, which is basically fancy wording for a study on the timing of medications. It turns out that this is very important. 

Why? The renin angiotensin system, where your kidneys help regulate your blood pressure through secretion of these mediators, leads to higher aldosterone levels in the morning hours. 

People who took their blood pressure medication at night showed a: 

  • 56% reduction in cardiovascular deaths
  • 34% reduction in myocardial infarction heart attacks
  • 40% reduction in revascularization procedures 
  • 42% reduction in heart failure
  • 49% reduction in stroke 


Treating High Blood Pressure 


I am much more likely to treat high blood pressure than I used to be. I want to get that blood pressure down!

There are various classes of blood pressure medicines. The results from this study are particularly true for the ACES (most common is Lisinopril) and ARBS (most common is Losartan). Both of these medications are good if you need to take something just for your blood pressure.

Sometimes as you get older, you inherently are going to get hardening of the arteries. I know this first hand as a 66 year old who had a perfect CT Calcium Score of zero 10 years ago to having a 92 now. This isn’t bad since I have no risk factors, but it’s still hardening of the arteries. 

There’s lots of things I’m doing for this and one of them is getting my blood pressure lower. 

It truly is a silent killer. You don’t feel your blood pressure getting higher. 

ARBS are my first choice for blood pressure reduction because most of the time there are less side effects than the other blood pressure medicines. 

I’ve always told people to take their night time 81mg aspirin because most cardiac events happen early in the morning. The idea is that you want to be most protected at night. 

Although it’s really difficult to get a 24 hour ambulatory blood pressure reading, it turns out that people that had their blood pressure go up at night had tremendous increases in cardiovascular events. 

This goes back to having good sleep habits which is why getting a sleep study can be great, or even wearing a CPAP mask if you need one. Sleep apnea is responsible for a lot of sudden deaths, a lot of hypertension, obesity, chronic fatigue, as well as a host of other ailments. 

So this is important news. Think about taking your blood pressure medication at night (if you’re on one) unless directed otherwise by your own personal physician. 

As you can see I’ve changed my tune about this. 

In addition to getting lean and getting a good night’s sleep, if you’re on a blood pressure medication consider taking it at night. This study is well thought out with lots of participants. 

Think about this. It may save your life. 

*Note: There may be special circumstances where you should take your blood pressure medicine during the daytime, in the same way you take any diuretic. Also, if you have heart disease and experience daytime angina, you may want to take your calcium channel blocker or your beta blockers during the daytime. 

Talk it over with your physician. I wish there was a 24 hour blood pressure monitoring available for everyone with high blood pressure, so we could better determine what is the optimal time for your body to take blood pressure medicine.