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Take hypertension medication anyTIME

Presented by
Prof. Thomas MacDonald, University of Dundee, UK
ESC 2022
The pragmatic randomised TIME trial, with over 5-year follow-up in >21,000 patients with high blood pressure, reported that taking antihypertensive medications in the morning or the evening provides identical protection against heart attack, stroke, or vascular death.

Prof. Thomas MacDonald (University of Dundee, UK) presented the results of the TIME study (ISRCTN18157641). The smaller Hygia study had previously suggested that there might be a substantial cardiovascular benefit of evening dosing of antihypertensive medication [2], and Prof. MacDonald explained that TIME aimed to test this hypothesis in a large prospective, randomised trial.

Participants already taking at least 1 antihypertensive medication were randomised 1:1 to take their usual antihypertensive medication in the morning (n=10,601) or the evening (n=10,503). The composite primary endpoint was hospitalisation for non-fatal myocardial infarction (MI) or non-fatal stroke, or vascular death. Information on hospitalisation and deaths was obtained from participants by email and through record linkage to national databases and further data was gathered from family doctors and hospitals, and independently adjudicated by a committee blinded to allocated dosing time.

The results showed that the time of dosing made no difference. With a median follow-up of 5.2 years, a primary endpoint event occurred in 3.4% of participants in the evening dosing group as opposed to 3.7% in the morning dosing group (HR 0.95; 95% CI 0.83–1.10; P=0.53). The results did not vary in pre-specified subgroup analyses.

Prof. MacDonald concluded: “TIME was one of the largest cardiovascular studies ever conducted and provides a definitive answer on the question of whether blood pressure lowering medications should be taken in the morning or evening. The trial clearly found that heart attack, stroke, and vascular death occurred at a similar degree, regardless of the time of administration. People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them and minimises any undesirable effects.”

  1. McDonald T, et al. TIME - The Treatment in Morning versus Evening study. Hot Line Session 1, ESC Congress 2022, Barcelona, Spain, 26–29 August.
  2. Hermida RC, et al. Eur Heart J. 2020;41(48):4565–4576.


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