Bedtime Dosing Bettered Morning Dosing in High BP

A Chinese prospective, randomized, parallel-group, superiority clinical trial revealed that bedtime dosing provides superior nocturnal blood pressure (BP) control and circadian rhythm improvement without compromising daytime or 24-hour BP control. The trial was conducted at 15 hospitals in China between June 2022 and April 2024 with a 12-week follow-up, compared morning (6:00–10:00 am) versus bedtime (6:00–10:00 pm) administration of medication in patients with high BP who were either untreated or had discontinued therapy for at least two weeks. Participants received a daily single-pill combination of olmesartan (20 mg) and amlodipine (5 mg), with dosage adjustments at weeks 4 and 8 based on BP measurements. The primary outcome was the change in nighttime systolic BP from baseline to 12 weeks, while secondary outcomes included changes in office and ambulatory BP indicators, analyzed in both intention-to-treat and per-protocol populations. Among 720 randomized patients (mean age, 55.5 years; 56.8% men), baseline BP was similar between groups. Compared with morning dosing, bedtime dosing achieved significantly greater reductions in nighttime systolic BP (−3.0 mm Hg) and diastolic BP (−1.4 mm Hg), with higher rates of nocturnal systolic BP control (79.0% vs 69.8%) and improved circadian rhythm (the proportion of a nocturnal BP dip), without increasing nocturnal hypotension. The findings support the potential advantages of bedtime dosing. Source: https://jamanetwork.com/