Ingestion-time – relative to circadian rhythms – differences in the pharmacokinetics and pharmacodynamics of hypertension medications

Proper management of hypertension requires awareness of known ingestion-time differences in both the PK of individual BP-lowering medications and their combinations, which arise from circadian rhythms affecting absorption, distribution, metabolism, and elimination, and their PD, which result from circadian rhythms in mechanisms that regulate the 24 h BP pattern. The vast majority of the multiple published trials document substantially enhanced lowering of asleep BP, increased sleep-time relative BP decline (dipping), and markedly better reduction of CVD morbidity and mortality when hypertension medications and their combinations are ingested at bedtime rather than upon waking.