A multicenter, controlled, prospective endpoint trial confirmed that routinely taking blood pressure (BP)-lowering medications at bedtime, as opposed to upon waking, resulted in improved ambulatory BP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and markedly reduced major cardiovascular disease (CVD) events. The trial included 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) 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, ambulatory BP monitoring was performed for 48 h. During a 6.3-year median follow-up, 1752 patients experienced the primary CVD outcome. Adjusted for significant influential characteristics, patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower 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). The bedtime treatment was at least as safe, and with similar patient compliance and adherence, as usual upon-waking treatment. The findings are consistent with previous studies. Source: https://academic.oup.com/eurheartj/
