Timing Drugs to Body Clocks Enhances Effectiveness: Study

A new analysis published in The Lancet journal's eClinicalMedicine suggested that timing blood pressure medication to align with a person's "chronotype"—whether a night owl or an early bird—may reduce the risk of a heart attack.

Blood pressure drugs have been central to chronotherapy due to blood pressure's circadian rhythm, which peaks in the morning and dips at night. This healthy dip often vanishes in individuals with diabetes, kidney disease, and sleep apnea.

Some physicians have recommended taking medications at bedtime to restore the dip, but studies have produced mixed results, making this advice less common recently. However, emerging research suggests that timing medications to align with the body's natural rhythms could reduce side effects and enhance the effectiveness of various treatments, including vaccines, cancer therapies, and medications for depression, glaucoma, pain, and seizures.

In the study, the University of Dundee conducted the TIME study, a larger randomized, controlled trial in 2022. Researchers tracked over 21,000 participants taking hypertension drugs either in the morning or at night over several years and found no significant difference in cardiovascular outcomes.

To further investigate, researchers analyzed the data based on participants' chronotypes, distinguishing between "night owls" (late-to-bed, late-to-rise) and "morning larks" (early-to-bed, early-to-rise). This additional analysis aimed to determine if aligning medication timing with personal sleep patterns could impact treatment efficacy.

The results showed that among the 5,358 participants in the TIME study, "night owls" who took their blood pressure medication at bedtime had a 34% lower risk of hospitalization for a heart attack. Conversely, their risk increased by 62% when taking the medication in the morning. For "morning larks," the pattern was reversed: taking the medication in the morning was associated with an 11% lower risk of heart attack while taking it at night led to an 11% higher risk.

These findings highlighted the importance of considering individual chronotypes when prescribing blood pressure medication.

Reference: Filippo Pigazzani, Kenneth A. Dyar, Steve V. Morant, Céline Vetter, Amy Rogers, Robert W.V. Flynn, et al.; Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes: the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study; EClinicalMedicine; DOI:https://doi.org/10.1016/j.eclinm.2024.102633