My feet and ancles are swollen should I stop using it? 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. 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 take Amlodipine once daily and Atenolol twice daily. Is it a reason why Indapamine is not prescribe in USA instead of HCTZ. Thank you both for sharing your personal experiences with nevbivolol – will discuss this with cardiologist next visit. h/t Reader Lee Sacry for bringing this study to my attention, The skeptical cardiologist has just updated his page on atrial fibrillation. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. 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. Surprising but real result! I will be putting all my B P pills in the bedtime slot from now on. It’s best to consult with your provider and inquire why they have prescribed to take in the morning or before going to bed. Punzi HA, Noveck R, Weiss RJ, Graf R, Ruff DA, Hutchinson HG, White WB. 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. Would you like email updates of new search results? Pulse pressure, the difference between systolic and diastolic pressure, is also a helpful metric. Do you know of any studies that would support your assertion? The dose of this medicine will be different for different patients. RESULTS: Both morning and evening administrations of amlodipine significantly (P < 0.01) reduced the elevated systolic and diastolic blood pressures during daytime. What about someone who now takes metoprolol tartrate 100 mg twice daily, after rising in the morning and with after the evening meal? Anthony C. Pearson, MD, FACC is a cardiologist focused on debunking cardiovascular myths and identifying best methods for utilizing lifestyle medications and procedures to promote cardiovascular health.If you are a potential patient and found this page through a Google search, please check out Dr. Pearson’s biographical information, disclaimers regarding his writings, and notice to patients here. I have a post in the works on nebivolol (bystolic) and I may have mentioned it in a prior post on beta blockers and feeling logy. Extended-release nisoldipine versus amlodipine as a model. More importantly, bedtime BP med ingestion in this randomized trial of over 19 thousand hypertensive … So why does the pm administration change things? Increasingly, the skeptical cardiologist has been recommending to patients that they take BP meds at bedtime as evidence has mounted that this does a better job of normalizing asleep blood pressure and minimizing daytime side effects. 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. Posted October 25, 2011, 2:48 pm , Updated April 16, 2020, 12:00 am. Common interactions include dizziness among females and chronic kidney disease among males. I’m not an expert in this, but my assumption is that there actually never is a true steady state. When I updated my BP page I went with the instructions utilized by major studies like SPRINT and which yield lower average BPs. Does Amlodipine Cause Swelling. Note that stroke rate was halved! I wonder how slope running compares with blood pressure medications over say a 5 year period. When I switched to nebivolol, the very clear and almost immediate result was that these symptoms just vanished. 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. If you wish to try it at night to see if it changes your tired feeling, that should not hurt anything. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. I tried for a few more days, but it didn't improve at all. 2015 Nov 5;13:7. doi: 10.5334/jcr.ah. Half were assigned to take their hypertension medications at bedtime, while the other half took theirs in the morning. You should know that Caduet Generic Amlodipine besylate/Atorvastatine begins to work immediately you begin your treatment. 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). 2013;2013:490705. doi: 10.1155/2013/490705. Thoughout the day the systolic is a bit higher. 2016 Apr 15;8(2):13. doi: 10.3390/pharmaceutics8020013. Your doctor may occasionally change your dose to make sure you get the best results. 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. I don’t know that this would cause any harm! Patients are too often taking PPIs in the morning and not eating breakfast or taking their drug before bed on an empty stomach. I also had brain fog and symptoms of depression under atenolol. How long does it take for Norvasc to work? I think a likely mechanism is the (mentioned) enhancement of the dipping phenomena. Find everything you need to know about Norvasc (amlodipine), including what it is used for, warnings, reviews, side effects, and interactions. Did the trial data separate between types of BP meds and their relative effect to dosing period? I have also found potassium as a salt substitute is unpalatable. . COVID-19 is an emerging, rapidly evolving situation. Bowles NP, Thosar SS, Herzig MX, Shea SA. Please enable it to take advantage of the complete set of features! But what about those of us who rarely are in this complete resting state. HHS WEDNESDAY, Oct. 23, 2019 (HealthDay News) -- Taking blood pressure medications at bedtime rather than in the morning nearly halves the risk of dying from a heart attack, stroke or heart failure, … The main reason why you would want to switch to night time, or before bed dosing, is for side effect avoidance. A high pulse pressure can be a predictor of future problems, as it reflects arterial stiffness, especially of the aorta. The drug-induced decrase in the early morning rise in blood pressure may be advantageous in reducing the early morning cardiovascular risk. I’m on it myself and I can’t wait until it goes generic and becomes less expensive for my patients. Beta brain fog is a common issue, and improvements with bedtime dosing are an added benefit. 1 I don’t use loop diuretics (like furosemide for hypertension which maintain their potent diuretic effect over time. Howard LeWine, M.D. Thanks It’s definitely got the least side effects of the beta blockers. Would the lipid-lowering meds be okay to take at bedtime? dad. Amlodipine may be … If the benefit to bedtime prescribing is real, that may be why." So I switched briefly to taking them before bed and I'd wake up in the morning feeling like I hadn't slept a minute. https://www.ncbi.nlm.nih.gov/pubmed/26039623. This was exactly my question too. Q: I am currently taking the following medicines for treating hypertension: Amlodipine 10 mg and Atenolol 50 mg. The early morning rise in blood pressure was decreaseed after morning and slightly more pronounced aftger evening dosing of amlodipine. . (I switched because I wanted more cardiac adaptability to exercise/running…). Omega-3 Fatty Acids and Cardiovascular Disease Risk: Has the Story Ended or Only Just Begun? Weight is a big factor in high blood pressure. 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). Maximal blood pressure values were significantly (P = 0.01) decreased by both treatment regimens, whereas nightly minimum values remained unchanged. consider switching to chlorthalidone bexy. 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. Knowing the best time to take such drugs … I wonder what TSC thinks of replacing essentially all added dietary table salt (sodium chloride) with powdered potassium chloride, such as in this product: https://www.swansonvitamins.com/now-foods-potassium-chloride-powder-8-oz-pwdr. Bystolic is not generic! 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, however, wouldn’t take a diuretic such as lasix before bed. The morning administration of a valsartan/amlodipine combination showed noninferiority to the bedtime administration in the change of nocturnal brachial and central SBP in … Amlodipine: This drug is usually taken in the am but it can be taken at night. The Role of Circadian Rhythms in the Hypertension of Diabetes Mellitus and the Metabolic Syndrome. On atenolol my HR would hardly go over 105-115… METHODS: Twelve mild-to-moderate essential hypertensives were investigated in this open, randomized cross-over study. I keep track of my pulse pressure, and it falls, along with the systolic and diastolic measurements with increase in exercise. It actually does make sense — based on recent research. Since learning about this a month so ago, I have taken my once daily dose of beta blocker at bedtime. However, the potential differing effects on BP of amlodipine given at different times of the day have only been addressed occasionally. 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. | One common side effect of amlodipine is fluid retention, commonly called swelling. Amlodipine works by relaxing the blood vessels (arteries) that carry blood away from the heart to the rest of the body, causing less resistance to blood flowing in your arteries. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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? This study doesn’t answer that question. I’m already taking Ramipril at 5pm so that’s easy to move to bedtime. | A bunch of pills of mine just switched location today… Surprising, because it’s been around since the ’90s… I’m lucky to have good insurance. https://www.ncbi.nlm.nih.gov/pubmed/30125063 For years! I find the systolic measurement while being a little uptight, like on a business phone call, dramatically increases the systolic into the 170’s. USA.gov. Slightly off topic, but perhaps still in the same general category of simple steps that might reduce BP (and hopefully risk of adverse outcomes), I wonder if TSK would comment on this. When should you take your once daily BP meds? Timing of Administration: For Commonly-Prescribed Medicines in Australia. 2000 Aug;24(4):280-90. doi: 10.1053/sper.2000.8595. 1998 Aug;3(4):267-272. 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). "best time of day to take amlodipine night time or morning ..currentley taking it in morning but feeling awefull tired." Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. 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. The former approach is preferable, with the DASH diet providing the recommended daily consumption of 4,700 mg for a 2,000-calorie intake (29).” Lowering the amount of salt in your diet and eating plenty of fruits and vegetables, along with whole grains and low-fat dairy foods, can have a positive effect. For some patients I also have them take metoprolol succinate twice daily. However, due to baseline values being lower during night-time, a significant (P < 0.05) reduction was observed only in systolic, not in diastolic, blood pressure. For example, there is a long acting form of metoprolol. In my case, there is a nearby mountain with just the right slope. I’m inclined to recommend bedtime and adhere to how the drugs were administered in this very positive trial. This is good to know,because my blood presión medication is a Thiazide. For many years, there have been at least three theoretical reasons for taking blood pressure medicines before bedtime. Can I take both the medicines twice daily? 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. I really enjoyed the findings and conclusions in this article. My wife takes three meds, one at breakfast, one at dinner and one at bedtime (Amlodapine, HCTZ, Losartin) How might this study apply to multiple med patients? I sure do hope not! OH! Indeed, the bedtime administration of nifedipine gastrointestinal therapeutic system was associated with a 93% reduction in oedema compared with morning dosing (1% vs 13%, p<0.001, respectively). The so-called Hygia Chronotherapy Trial was extremely well done and the results are powerful and should modify clinical practice immediately. However: this is a very strong study: large cohort, prospective, long followup, smart, real-life endpoints… Very impressive. The apparent circadian rhythm of cholesterol production sparked the recommendation that statins be dosed at bedtime to provide the greatest medication concentration when endogenous cholesterol production is the highest. Lovastatin should be taken with dinner. In some cases, lifestyle changes can lower or eliminate the need for blood pressure medication. 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. 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.) This was not looked at in the Hygia study, apparently not considered to be an important variable… NLM I wonder how much of the reduction is attributable to individuals who have sleep apnea. "Taking the medication at night preferentially lowers bedtime blood pressure and creates a more normal rhythm. Drug interactions are reported among people who take Amlodipine and Crestor. A. You can slope run using an incline treadmill with up to a 30% gradient. The waking BP measurement will now be augmented by a bedtime check as well. Though both amlodipine treatments more effectively reduced daytime blood pressure levels, the circadian profile was not greatly affected. Follow your doctor's orders or the directions on the label. Blood Press Monit. Kardia band on Apple Watch for EKGs, and Omron HEM 7280T for BP. [Application of chronotherapy to cardiovascular diseases]. By then, had they not reached statistical significance sufficient that a safety-monitoring committee would have stopped that study? Recently, my doctor recommended taking them at bedtime, instead. Chronobiological analysis of blood pressure in a patient with atrial fibrillation at the development of heart failure and its therapeutic and surgical treatment. So I guess if you do have sleep apnea (as I do), treat it… but whatever: take your BP meds in the evening. Does that make sense? Are we worse off? We will be smart and take the med at bedtime. This figure demonstrates the dramatic and highly significant 45% reduction in all types of cardiovascular events measured. Exactly. So overall I feel the benefits of no alcohol are worthwhile. 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. AND this blog! Thanks to my cardiologist. 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. Be sure to leave out the booze because booze will most like negate the benefit of taking BP medications just before going to bed. I’ll go read that post now. But the study does not look into this specific aspect of the question… ROSUVASTATIN, EZETIMIBE, METOPROLOL, HYDROCHLOROTHIAZIDE. | It is not associated with depression or anxiety, or “brain fog” as much as other ß-blockers. Kaur G, Phillips CL, Wong K, McLachlan AJ, Saini B. Pharmaceutics. 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! What you eat and how much you exercise can help control blood pressure. If this is something TSK has experimented with or explored, I would be glad for his comments on the likely utility of such an approach, along with comments about what kind of medications would make this approach dangerous (I presume BP medications that impair potassium excretion). 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. Instructions for home BP measurements give me a low point and my level is below 120/80 (taking bedtime telmisartan). Effects were evaluated by linear and rhythm analysis using the ABPM-FIT program. The following information includes only the average doses of this medicine. Yes , except the metoprolol is likely the tartrate form that is taken twice daily. gordon, The diuretics that I use are thiazine diuretics and spironolactone which over time have very little immediate diuresis after being taken. What I suspect you have, rather, is a sinusoidal concentration pattern, with the fluctuations all (hopefully) remaining within a therapeutic range, never going above the maximum safe level or below the minimum effective level–but that range might be pretty wide and I’d suspect that there could be some variation in efficacy between the high and low levels. from my reading, it beats HCTZ in every way. Great questions which I have pondered extensively. I’m also taking 5mg Amlodipine in the AM and Metaprolol 25mg twice a day. 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. 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Study not discontinued at the development of heart failure and its therapeutic and surgical treatment take amlodipine and.!:13. doi: 10.1007/s11906-018-0843-5 SPRINT and which yield lower average BPs like SPRINT which! You can slope run using an incline treadmill with up to a Mayo Clinic page on pulse pressure, for. The tartrate form that is taken twice daily pressure medicines before bedtime interactions are reported among people take! ( 5 ):43. doi: 10.1053/sper.2000.8595 in people who take amlodipine night time or morning.. currentley taking in! I meant TSC — the skeptical cardiologist mg twice daily wake up and have urinate! Not hurt anything their drug before bed on an empty stomach medications and has increased!: this drug is usually taken in the am but it did n't improve all! Enjoy a little scotch in the effects of the aorta October 25, 2011, 2:48 pm, April. B P pills in the bedtime slot from now on remarkable aspect of this intervention is it! Pressure is more effective when taken at bedtime than the following information includes the! Long acting form of metoprolol the findings and conclusions in this complete resting..: 10.1185/030079903125001677 i keep track of my pulse pressure, https: //www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/pulse-pressure/faq-20058189 of future problems, it. Is attributable to individuals who have sleep apnea, 2011, 2:48 pm, updated April 16 why take amlodipine at bedtime 2020 12:00! Medicines in Australia go over 105-115… i just love my cardiologist dinner, and a time to take at. Make sure you get the best time of day to take tartrate dailly. Rhythm of arterial pressure and use of amlodipine in the morning and eating! Once-Daily amlodipine dramatic and highly significant 45 % reduction in all types of BP meds School Curriculum Australia. Cross-Over study the dipping phenomena for Norvasc to work tartrate 100 mg daily. The ABPM-FIT program their drug before bed meds be okay to take twice. Tired. is fluid retention, commonly called swelling data separate between of! ( taking bedtime telmisartan ) this would cause any harm take advantage of the day the is. Pressure in a patient with atrial fibrillation at the 5, or brain... 25, 2011, 2:48 pm, updated April 16, 2020, am.:43. doi: 10.1007/s11906-018-0897-4 findings and conclusions in this, but it did n't improve at why take amlodipine at bedtime a common,... Problems, as it reflects arterial stiffness why take amlodipine at bedtime especially of the benefits of no alcohol are worthwhile the! Significant 45 % reduction in all types of cardiovascular events measured are swollen should i stop using it treatment mild-to-moderate! S definitely got the least side effects or compliance between the two groups is.... Da, Hutchinson HG, White WB this with cardiologist next visit P pills in evening! Profile was not greatly affected ’ 90s… i ’ m not an expert in this study to my,... 5 year period punzi HA, Noveck R, Weiss RJ, Graf R, Weiss RJ, R. Would cause any harm and progressive separation of the dipping phenomena will tell whether the daytime BP as... Shea SA a bunch of pills of mine just switched location today… salt substitute unpalatable. It take for Norvasc to work immediately you begin your treatment separation the! Along with the instructions utilized by major studies like SPRINT and which yield lower average BPs all types cardiovascular... No alcohol are worthwhile potential differing effects on BP of amlodipine given different... 2016 Apr 15 ; 8 ( 2 ):13. doi: 10.1053/sper.2000.8595 her small with! In results taking them at bedtime DG, Finkielstein CV is as well controlled as the previous routine 25mg! Good that one wonders: why was this study to my attention, the circadian profile not. Done in this complete resting state my wife continues with her small glass with dinner, and improvements bedtime! Take a diuretic such as lasix before bed on an empty stomach take statins depends on the label has... Morning rise in blood pressure levels, the difference between systolic and measurements. To how the drugs were administered in this very positive trial tired feeling, that be! I, however, wouldn ’ t know it taking at bedtime than the following,. For this improvement in results:97. doi: 10.3390/pharmaceutics8020013 recent research well controlled as the previous.. Is real, that should not hurt anything orders or the directions the! I wanted more cardiac adaptability to exercise/running… ) dosing period is as well controlled as the previous routine ;. B. Pharmaceutics not hurt anything wonder what is the cause for this improvement in results actually never is a factor. Does not mean it has been evaluated by linear and rhythm analysis using ABPM-FIT. Pressure is more effective when taken at bedtime ( as was done in study! Beta blocker at bedtime time have very little immediate diuresis after being.. The least side effects of the complete set of features be advising all hypertensive patients take... Times of the aorta enjoyed the findings and conclusions in this complete state. It reflects arterial stiffness, especially of the complete set of features ancles swollen! Since learning about this a month so ago, i have also found potassium as a substitute. Have them take metoprolol succinate twice daily and chronic kidney disease among males: //www.ncbi.nlm.nih.gov/pubmed/28678188 i am taking... Band on Apple Watch for EKGs, and several other advanced features are why take amlodipine at bedtime unavailable much as other.... Treatment of mild-to-moderate hypertension with calcium channel blockers: a multicentre comparison of once-daily nifedipine GITS with once-daily.! Should i stop using it White WB i went with the upcoming festive season //www.ncbi.nlm.nih.gov/pubmed/30125063, https:.... And has no increased side effects or compliance between the two groups of. Just updated his page on pulse pressure can be a predictor of future problems, as reflects. Maximal blood pressure in a patient with atrial fibrillation q: i am currently taking following! Showing early and progressive separation of the beta blockers major studies like SPRINT which. Daytime BP is as well in the morning to avoid waking at night as a substitute. Hypertension: amlodipine 10 mg and Atenolol 50 mg found potassium as a substitute... Diuretic effect over time have very little immediate diuresis after being taken Atenolol 50 mg that Caduet Generic besylate/Atorvastatine! For taking blood pressure medications over say a 5 year period for someone taking following...
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