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(Hypertension. 2009;54:23.)
© 2009 American Heart Association, Inc.

Editorial Commentaries

Does It Matter When Drugs Are Taken?

Trefor Owen Morgan

From the Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia.

Correspondence to Trefor Owen Morgan, Department of Physiology, University of Melbourne, Melbourne, Victoria 3010, Australia. E-mail treforom@unimelb.edu.au

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Blood pressure varies throughout the day, being highest on awakening in the morning and lowest during sleep. However, the sleep blood pressure predicts cardiovascular and cerebrovascular ischemic events better than the awake blood pressure, which predicts hemorrhagic strokes.¹ Thus, the level of blood pressure interacts with the hormonal environment to determine the outcome. Similar observations have been made in rats in which the blood pressure during sleep is the principal determinant of cardiac enlargement.² A conclusion is that control of sleep blood pressure may be more important than control of awake blood pressure, although ideally blood pressure should be controlled throughout 24 hours. Relatively little attention has been paid to the time at which drugs should be administered, and, in general, the ideal is thought to be that they can be taken once a day and usually in the morning, because this is believed to improve compliance. This policy may lead to major undertitration of drugs, particularly those that have a short half-life or duration of action. Thus, the response to enalapril 5, 10, 20 or 40 mg is similar 3 to 4 hours after administration, but the 2 lower doses have little effect 24 hours later. The policy of taking the medication in the morning, particularly if the patient is seen 2 to 3 hours later, leads to a failure to control blood pressure during sleep and during the awakening hours, which probably compose the most critical period. A similar problem applies to most of the angiotensin-converting enzyme (ACE) . . . [Full Text of this Article]

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