Bedtime BP-lowering Medications Work Better

A Spanish multicenter, controlled, prospective endpoint trial suggested that routinely taking blood pressure (BP)-lowering medications at bedtime, as opposed to upon waking, results in improved ambulatory BP (ABP) control and decreased occurrence of major cardiovascular disease (CVD) events. A total of 19 084 hypertensive patients (60.5 ± 13.7 years of age,  8470 women) were assigned (1:1) to take the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ABP monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome. Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower adjusted hazard ratio of the primary CVD outcome [0.55] and each of its single components, i.e. CVD death [0.44], myocardial infarction [0.66], coronary revascularization [0.60], heart failure [0.58], and stroke [0.51]. Progressive decrease in the asleep systolic BP mean during the follow-up was the most significant predictor of reduced CVD risk. The results are consistent with previous trials and document that bedtime hypertension therapy is at least as safe as usual upon-waking therapy. Source: https://academic.oup.com/