A University of Alberta-led study has put to rest a long-standing controversy about the best time of day to take blood pressure medications — and in the process created a powerful research network of family doctors to answer important primary care questions.
The BedMed and BedMed Frail studies reported this week in high-profile online JAMA network journals, finding that medications to control high blood pressure work just as well when they are taken in the morning as when they are taken at bedtime.
The question had been pressing since 2010, when the first of a pair of Spanish studies reported a 61 per cent lower risk of heart attack, stroke, heart failure and death when the meds were taken in the evening.
"It seemed too good to be true because hardly anything gives you that kind of a risk reduction," explains BedMed principal investigator Scott Garrison, professor of family medicine and director of the Pragmatic Trials Collaborative.
A British study also tried to reproduce those results and showed no difference in outcomes based on the time of medication usage.
"In a sense, we're the tiebreaker of 'does it matter or not,' and our findings are that it doesn't make any difference," says Garrison. "The risks are not any different. The benefits are not any different."
Statistics Canada reports that between one-fifth and one-quarter of adult Canadians have high blood pressure, the top risk factor for stroke and a major contributor to heart disease according to the Heart and Stroke Foundation of Canada.
"Our findings support the patient being the one who decides when they want to take their blood pressure medication," Garrison says.
"If something sounds too good to be true, it is probably not true," writes Sandra Taler, professor of medicine at the Mayo Clinic, in an accompanying JAMA editorial. "At the end of the day, timing of medications doesn't matter as much as consistency in taking them. Regular dosing and use of long-acting medications should be emphasized and may better address concerns related to blood pressure variability."
BedMed was the largest randomized trial ever carried out in a Canadian primary care setting, following 3,357 patients with high blood pressure for five years and involving 436 primary care providers (429 family physicians and seven nurse practitioners) from Alberta, British Columbia, Saskatchewan, Manitoba and Ontario participating.
