Evening versus morning dosing regimen drug therapy for hypertension

Abstract

No RCT reported on clinically relevant outcome measures - all cause mortality, cardiovascular morbidity and morbidity. There were no significant differences in overall adverse events and withdrawals due to adverse events among the evening versus morning dosing regimens. In terms of BP lowering efficacy, for 24-hour SBP and DBP, the data suggests that better blood pressure control was achieved with bedtime dosing than morning administration of antihypertensive medication, the clinical significance of which is not known.

Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial

“…Moreover, the safety of bedtime-and morning-treatment regimens was similar, a finding consistent with previous publications reporting bedtime compared with morning BP therapy significantly improves ABP reduction without any increase in adverse effects [37]. Finally, antagonism of the RAAS by reduction of angiotensin II formation and blockade of its receptors achieved either by a bedtime ACEI or ARB ingestion strategy is superior to any other treatment strategy for reducing risk of new-onset diabetes.…”

Effect of bedtime administration of blood-pressure lowering agents on ambulatory blood pressure monitoring results: A meta-analysis

“…The synthesis analysis showed that the level of BP in the bedtime administration group was lower than in the morning administration group, which reduced diurnal SBP by 1 [19] found evening administration lowered 24-h SBP by 1.61 mm Hg and 24-h DBP by 1.23 mm Hg, which was a statistically significant difference. In particular, the alpha-blocker doxazosin GITS (4 mg/day) [20] and the diuretic torasemide (5 mg/day) [21] evening administration reduced 24-h SBP by 5.10 mm Hg and 6.24 mm Hg, respectively and 24-h DBP by 2.70 mm Hg and 5.95 mm Hg, respectively.…”

Evening Dosing of Antihypertensive Therapy to Reduce Cardiovascular Events: A Third Type of Evidence Based on a Systematic Review and Meta‐Analysis of Randomized Trials

“…20 However, in the more usual hypertensive population, the improvement in 24-hour control from evening dosing is a more modest 1.71 mm Hg systolic. 21 Why would targeting nighttime BP produce greater risk reduction than targeting daytime or clinic BP? One possibility is the better 24-hour control from evening dosing noted above.…”

“…However, a systematic review of 21 randomized trials of evening dosing (none of which included CVEs as outcomes) found no increase in withdrawal from evening treatment (RR=0.53 [95% CI, 0.26-1.07]) and no increase in adverse events (types not specified) in the evening dosing arm (RR=0.78 [95% confidence limits, 0.37-1.65]). 21 A concern regarding evening dosing is the potential for a "J-curve" effect on CVEs from an impact on BP that is already at a lower level in the evening, but a J curve was not demonstrated on examination of observational data. 27 …”