16-05-2025
Timing of BP Meds Doesn't Affect Outcomes: BedMed in Print
Timing of administration did not affect the risks and benefits of antihypertensive medication, and patient preference should guide the choice of morning vs nighttime dosing in adults with hypertension.
METHODOLOGY:
Two trials from the past two decades reported a substantial reduction in major adverse cardiovascular events (MACEs) with bedtime vs morning administration of antihypertensive medications, whereas another trial found no such benefits.
Researchers conducted a prospective randomized clinical trial to understand whether the timing of antihypertensive medications affects the risk for cardiovascular disease.
They included 3357 adults diagnosed with hypertension who were taking one or more once-daily antihypertensive medications (median age, 67 years; 56% women), recruited by primary care clinicians across five Canadian provinces between March 2017 and May 2022.
Patients were randomly assigned to take all once-daily antihypertensive medications either at bedtime (n = 1677) or in the morning (n = 1680).
The composite primary outcome was the occurrence of MACEs, defined as all-cause death or hospitalization/emergency department visits for acute coronary syndrome, stroke, or heart failure. Visual, cognitive, and other safety outcomes were also assessed.
TAKEAWAY:
Over a median follow-up of 4.6 years, the occurrence of MACEs did not differ significantly between patients taking antihypertensive medications at bedtime and those taking the medications in the morning. Findings were similar when each component of the primary outcome was evaluated separately.
Vision-related outcomes, including newly diagnosed glaucoma and subjective worsening of vision, did not differ significantly between patients taking antihypertensive medications at bedtime and those taking the medications in the morning.
The occurrence of falls, nonvertebral or hip fractures, syncope, lightheadedness, or cognitive outcomes did not differ between the two groups.
According to self-reported data at 6 months, adherence to once-daily medications was 83% in the bedtime group and 95% in the morning group.
IN PRACTICE:
'Loosening the rules on time of dosing may facilitate better supervision by caregivers, who may be able to provide assistance or oversight later in the day due to other responsibilities,' wrote Sandra Taler, MD, Mayo Clinic, Rochester, Minnesota, in an accompanying editorial.
'Regular dosing and use of long-acting medications should be emphasized and may better address concerns related to BP [blood pressure] variability,' she added.
SOURCE:
This study was led by Scott R. Garrison, MD, PhD, University of Alberta, Edmonton, Alberta, Canada. It was originally presented at European Society of Cardiology (ESC) Congress 2024 and published online on May 12, 2025, in JAMA .
LIMITATIONS:
The adherence to the allocated medication timing was self-reported and was lower in the bedtime group than in the morning group. The trial concluded early due to funding issues with fewer primary outcomes than previous trials.
DISCLOSURES:
This trial reported receiving funding from a multiyear grant to Support for Patient Oriented Research Innovative Clinical Trial from the Canadian Institutes of Health Research and a Partnership for Research and Innovation in the Health System grant from Alberta Innovates. The study also reported receiving in-kind research assistance from the Enhancing Alberta Primary Care Research Networks, which is funded by Alberta Innovates, and pilot funding from the Northern Alberta Family Medicine Fund. Several authors reported receiving grants or honoraria from or serving in different capacities in various organizations.
