Is night-time better than morning dosing of antihypertensives?

Bedtime dosing of antihypertensive medication is neither better nor worse than morning dosing when it comes to the subsequent risk of all-cause or cardiovascular mortality, according to a study.

A team of investigators obtained the vital status and cause of death from the death certificates of 28,406 treated hypertensive patients (mean age 62 years, 53 percent males), who were enrolled in the Spanish Ambulatory Blood Pressure Monitoring (ABPM) Registry between 2004 and 2014. Cox models were used, adjusted for clinical confounders and 24-hour systolic blood pressure.

Most of the patients (86 percent) received their medication exclusively in the morning, while 13 percent received it exclusively at night or at bedtime.

Over a median follow-up of 9.7 years, a total of 4,345 death occurred, of which 1,478 were attributed to cardiovascular causes. All-cause (hazard ratio [HR], 1.01, 95 percent confidence interval [CI], 0.93‒1.09) and cardiovascular mortality (HR, 1.04, 95 percent CI, 0.91‒1.19) in participants receiving evening medication dosing did not differ significantly from those who received morning medication dosing.

These results persisted in all subgroups of patients that were analysed.

“These findings are in accordance with results from a recent randomized controlled trial and do not support the hypothesis of a specific beneficial effect of night-time antihypertensive treatment dosing on risk of all-cause or cardiovascular death,” the investigators said.