Evaluation of Administration Time and Adherence Rates of Morning vs. Bedtime Dosing of Antihypertensive Medications

Abstract

Purpose The primary objective of this study was to evaluate the time of day patients administer antihypertensive medications. Secondary objectives were to evaluate medication adherence rates between morning and bedtime dosing and possible barriers to bedtime administration. Methods A single-center, cross-sectional study using a mixed-methods model containing a retrospective chart review and telephone survey was administered to hypertensive patients at a multidisciplinary, private practice clinic. Patients above the age of 18 with a diagnosis of hypertension were eligible for inclusion. The primary endpoint was the number of patients administering one or more antihypertensive medications at bedtime. Secondary endpoints were medication adherence and potential barriers of adherence to bedtime dosing. Results A total of 139 responses were collected. Most patients (75.5%) administered all antihypertensive medications in the morning, with only 24.5% of patients administering at least one antihypertensive medication at bedtime. Adherence was higher for medications administered in the morning compared to medications administered at bedtime, 87.8% and 79.4%, respectively. Limitations to this study include the single-center design and potential for patient recall and reporting bias when using self-reported data. Conclusion Results of this study suggest that the prevalence of bedtime administration of antihypertensive medications is low. Although self-reported adherence rates were higher with morning dosing compared to bedtime dosing, adherence rates for bedtime dosing were still promising. Future studies should be conducted to expand on existing morbidity and mortality evidence as well as prevalence of and adherence to bedtime dosing of antihypertensive medications.

Tolerability of bedtime diuretics: a prospective cohort analysis

“…In a 2017 survey of hypertensive primary care patients (single centre in Ohio, 139 respondents), 75.5% used all of their antihypertensive medication in the morning. 29 Of the same population, 21 of 22 thiazide-diuretic users (95.5%) took that thiazide in the morning. Although roughly 14% of hypertensive primary care patients will newly experience nocturia as a major burden after switching a thiazide diuretic from morning to bedtime, the vast majority of morning diuretic users can successfully make the switch to bedtime should it become clinically indicated to do so.…”

Update on trials examining effects of night-time blood pressure lowering drug treatment on prevention of cardiovascular disease

“…Morning drug takers were less likely to miss the dose [34]. Results from studies by Perry et al [33] and Vrijens et al [34] should be interpreted carefully due to a lack of formal tools to assess drug adherence although they reflected adherence rate in usual practice. In a recent meta-analysis by Hermida et al [35], no significant difference in adherence rate between morning and night-time doses was reported in included randomised controlled trials with an average adherence rate of more than 90% for both groups.…”

“…Given the current uncertainty of night-time BP lowering drugs, once daily dose of antihypertensive drug treatment is recommended to take at the most convenient time for patients. In a cross-sectional study by Perry et al [33], only 25% out of 139 participants were taking at least one antihypertensive drugs at night in which angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB), beta-blockers and calcium channel blockers (CCBs) were the most common drugs. Self-reported adherence to night-time dose was lower than those with morning dose but a promising adherence rate of 70% was reported in this exploratory analysis.…”

Arterielle Hypertonie – Was war 2020 wichtig?

“…Aufgrund der genannten Limitationen kann eine generelle abendliche Gabe der antihypertensiven Medikation nicht empfohlen werden [ 18 ]. Hinzu kommt, dass die Medikamentenadhärenz außerhalb klinischer Studien möglicherweise bei morgendlicher Einnahme höher ist [ 27 ].…”