Does bedtime ingestion instead of morning ingestion of hypertension medications produce better cardiovascular disease risk reduction in adults with hypertension?
This study found a significant reduction in mortality and morbidity among patients who took their once-daily antihypertensive medications at bedtime instead of on awakening. Although no significant difference occurred in compliance rates between bedtime and awakening ingestion times in this study, individual experiences may differ in clinical practice. 1b-
Randomized controlled trial (single-blinded)
Outpatient (primary care)
These investigators identified 19,168 adults, 18 years or older, who met standard criteria for hypertension that required prescription treatment to lower blood pressure (BP). The study participants randomly received (uncertain concealment) assignment to the intervention group and were told to ingest the entire daily dose of one or more prescribed BP-lowering medications at bedtime, or to the control group and were told to ingest the entire daily dose on awakening. Clinicians provided care without restriction to choice of BP-lowering medication approved for once-daily dosing (eg, angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, calcium channel blocker, beta-blocker, and/or diuretic). Statins, aspirin, and diabetes medications were also prescribed as needed and ingested as recommended. Individuals masked to treatment group assignment assessed outcomes, including the primary composite outcome of myocardial infarction, coronary revascularization, heart failure, stroke, and CVD death. Complete follow-up occurred for more than 99% of participants at a median of 6.3 years. Using intention-to-treat analysis, significantly fewer patients in the bedtime group experienced the primary cardiovascular disease outcome (n = 1752 total) compared with the awakening group (adjusted HR = 0.55; 95% CI 0.50 - 0.61; number needed to treat = 20.3; 17.4 - 24.3). Adverse events occurred similarly in both groups. Similarly poor adherence was reported at any visit during follow-up in both groups (approximately 3%).
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill