Is administering BP medication in the evening better than in the morning?

A recent meta-analysis showed that administering blood pressure (BP)-lowering drugs in the evening compared with in the morning did not decrease the risk of major adverse cardiovascular events (MACE). Thus, the authors argue that daily BP-lowering medication can be taken at a time that is most convenient for the patient.

“BP follows a circadian rhythm, with a peak after awakening and the lowest values during sleep,” explained Dr Ricky Turgeon (University of British Columbia, Canada) [1]. “The lack of BP decline at night has been associated with an increased risk for MACE. It might, therefore, be that evening administration of BP-lowering medication yields better outcomes with respect to MACE.”

Dr Turgeon and co-investigators performed a meta-analysis to analyse the risk of MACE as an effect of the time of day that antihypertensive agents are taken. The analysis included 5 trials (i.e. MAPEC, Hygia, TIME, BedMed, and BedMed-Frail) with data from 46,606 participants. Most trials had a follow-up duration of approximately 5 years.

No significant effect was seen of evening administration compared with morning administration on MACE (HR 0.71; 95% CI 0.43–1.16). “If we excluded the 2 trials with a high risk of bias, the effect of evening administration appeared to be even closer to 1,” added Dr Turgeon (HR 0.94; 95% CI 0.86–1.03).

“Thus, evening administration was not associated with a reduced risk of MACE,” concluded Dr Turgeon. “The evidence does not support the concept of chronotherapy in hypertension management.”

1. 
   
   1. Turgeon R, et al. Meta-analysis of trials of antihypertensive medication bedtime dosing including individual-patient data from BedMed and BedMed-Frail. HOTLINE 2, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024