Evening administration of drugs to lower blood pressure (BP) did not reduce the risk of cardiovascular events or death compared with morning administration, according to research presented at a Hot Line session today at ESC Congress 2024.
Evidence suggests that higher-than-normal BP levels at night are associated with an increased risk of cardiovascular events. However, trials that have evaluated the impact of nocturnal administration of BP-lowering drugs have shown mixed results. In this meta-analysis, we pooled all trial data and concluded that timing of dosing did not influence outcomes.”
Professor Ricky Turgeon, study presenter from the University of British Columbia, Vancouver, Canada
A systematic review and meta-analysis was performed that included all parallel-group randomized controlled trials (RCTs) comparing nighttime and morning administration of all BP-lowering drugs. Studies had to have at least one cardiovascular outcome of interest, with a follow-up of ≥500 patient years per group and a median follow-up of ≥12 months. Trials were assessed using the Cochrane Risk of Bias 2 tool.
The primary endpoint was major adverse cardiovascular events (MACE, a composite of death from any cause, nonfatal myocardial infarction, nonfatal stroke, and heart failure exacerbation). Secondary endpoints included individual components of MACE, all-cause hospitalizations, and specific safety events (fractures, glaucoma-related events, and cognitive decline).
Five RCTs were included with 46,606 patients – BedMed, 2 BedMed-Frail, 2 TIME, 3 Hygia4 and MAPEC.5 The BedMed, BedMed-Frail and TIME trials were judged to be at low risk of bias overall, while there were some concerns about bias with Hygia and MAPEC, particularly regarding the randomization process.
In the five trials, the incidence of MACE was not affected by evening versus morning dosing (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.43-1.16). In a sensitivity analysis based on risk of bias, the HR was 0.94 (95% CI 0.86–1.03) for MACE with evening versus morning dosing in the three trials judged to have low bias and 0.43 (95% CI CI 0.26–0.72) in the two trials with concerns of bias.
There was no difference in all-cause mortality for evening and morning dosing (HR 0.77, 95% CI 0.51–1.16). Similarly, all other secondary endpoints were unaffected by evening versus morning dosing, including fractures, glaucoma events, and cognitive events.
“Results from the meta-analysis provide compelling evidence that there is no difference between evening and morning dosing. Patients should take their blood pressure-lowering medication once a day whenever it best suits their preferences and circumstances.” Professor Turgeon concluded.
