When it comes to preventing a stroke or other cardiovascular emergencies there are risk factors we can’t control, like our age or family history. Fortunately, there are other risks — smoking, high blood pressure, diabetes, lack of exercise, poor diet, overweight, high cholesterol, atrial fibrillation — that can be controlled or managed.

High blood pressure, or hypertension, is one of the most important of these controllable risk factors and for many people it is also one of the easiest to control with medication and lifestyle changes. Some people can get their blood pressure controlled with diet and exercise alone, but most rely on medication.

Hypertension, along with the drugs used to treat it, have been in the news lately and it might be helpful to summarize two recent studies to see if they impact you or a loved one.

When to take blood pressure medication

The peer-reviewed European Heart Journal just published results of a six-year study of over 19,000 patients, confirming what many experts had already suspected: it is better to take blood pressure medications at bedtime. People who take all of their blood-pressure medication at bedtime have better blood pressure control and a significantly lower risk of heart or stroke death or illness compared to those who take their blood pressure medication in the morning.

The researchers found that patients who took their medication at bedtime reduced their risk of dying from or suffering heart attacks, stroke, heart failure or other cardiovascular problems by 45% compared to those who took their medication after waking up in the morning. Always check with your doctor before making any changes in your medication routine.

Which blood pressure medications should you take?

A recent study published in medical journal the Lancet pulled together the data of 4.9 million patients to look at how well each of the main drug types used to treat hypertension prevented heart attack, heart failure, and stroke — and to what extent each drug caused 46 unwanted side-effects.

The key finding was that thiazide or thiazide-like diuretics are better at preventing heart attack, heart failure, and stroke than ACE inhibitors, while also being safer than ACE inhibitors. (ACE inhibitors are the blood pressure drugs that end in -pril, such as lisinopril)

Thiazides are inexpensive and have been around for years, meaning that the risks and benefits are well-understood. The Lancet study concluded that it is better and safer to at least start with thiazide diuretic over an ACE inhibitor when first treating a patient for high blood pressure.

If you are already successfully taking an ACE inhibitor, don’t rush to get off it. Most people find that it takes a combination of two or more blood pressure medications to get their blood pressure under control. Different medications work in different ways in the body to affect blood pressure, and it takes time, patience, and working closely with your doctor to get the right medications and doses to keep your blood pressure in the normal range, but it’s worth it.

CHQ250 is an initiative of the Chautauqua Health Action Team (CHAT), encouraging you to take action to be one of at least 250 strokes, heart attacks, or related deaths prevented in Chautauqua County in the coming year. This column is written by CHAT members to share information to help you to do your part to live a life free of stroke or heart disease; it is not intended to replace advice provided by your healthcare team. Please direct questions or comments to: activecounty@co.chautauqua.ny.us.