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by E. Wayne Combs
U.S. Army Center for Health Promotion and Preventive Medicine
High blood pressure has a significant impact on the military healthcare system. And don’t think that just middle-aged and elderly people suffer from it!
In fiscal year 2007, the Army wrote more than 390,000 prescriptions for medicines used to treat HBP in the active-duty population, totaling more than $8.7 million. Those figures for the entire DOD active-duty population are estimated at 857,000 prescriptions totaling more than $17.8 million. Although HBP usually has no symptoms, it can cause serious chronic problems such as strokes, heart failure, heart attacks and kidney disease.
The good news is you can control HBP through healthy lifestyle habits and taking medicines, if needed. Better control of HBP could help reduce the enormous amount of money spent on medicines and – most importantly – substantially decrease the more serious chronic problems caused by HBP.
Whether you take your blood pressure medicine in the morning or at night may be very important in blood pressure control. Researchers in Italy report that taking blood pressure medicine at night instead of in the morning helped restore normal nighttime blood pressure in some patients. This simple switch may also help reduce the risk of heart and kidney disease.
Why? Everyone has a 24-hour internal clock that may actually make certain diseases worse at certain times of the day and, in turn, affect the time we should take medicine. In healthy people, blood pressure dips at night by 10 to 20 percent.
When it comes to blood pressure, you want to be a dipper. Scientists do not know why, but suspect the drop gives our arteries a little rest. People with HBP that does not dip at night, the so-called “non-dippers,” appear to develop more serious heart disease.
Also, the 26 million Americans with chronic kidney disease seem more likely to be non-dippers. In addition to heart problems, they are at extra risk of needing dialysis because of kidney damage. Dr. Lawrence Appel of Johns Hopkins University found 80 percent of African-American kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels. Two-thirds of chronic kidney disease patients and at least 10 percent of the general population are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation.
Yet few patients have ever heard of the problem. And few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can help but is rarely used, partly because insurance seldom pays for the extra doctor visit to download and diagnose the readings. And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.
This does not mean everyone should start taking their blood pressure medicine at night. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. You should never change the time you take your medicines without consulting your healthcare provider. Still, it’s worth finding out if changing the timing of your medicine may help you. More information on this and other heart-related topics can be found at http://www.americanheart.org/.
