When is the best time to take antihypertensives?

It remains uncertain whether morning or bedtime dosing of antihypertensive drugs is better than the other in terms of efficacy, but the latter appears to significantly reduce the incidence of myocardial infarction (MI), suggests a study.

A team of investigators identified relevant randomized controlled trials (RCTs) using the databases of Embase, Scopus, PubMed, Central, and Web of Science until 13 October 2022. They then pooled risk ratios (RRs) for dichotomous outcomes with the corresponding 95 percent confidence interval (CI).

Five RCTs, including a total of 59,200 participants, met the eligibility criteria. Bedtime dosing significantly correlated with less incidence of MI (RR, 0.80, 95 percent CI, 0.70‒0.91; p=0.0007) when compared with morning dosing of antihypertensive medications.

On the other hand, no statistically significant difference was observed between morning and bedtime dosing in terms of the following outcomes: all-cause mortality (RR, 0.77, 95 percent CI, 0.51‒1.16; p=0.21), cardiovascular mortality (RR, 0.65, 95 percent CI, 0.35‒1.21; p=0.17), major adverse cardiac events (RR, 0.79, 95 percent CI, 0.56‒1.10; p=0.16), heart failure (RR, 0.68, 95 percent CI, 0.42‒1.09; p=0.11), cerebrovascular accidents (RR, 0.80, 95 percent CI, 0.53‒1.22; p=0.30), coronary revascularization (RR, 0.79, 95 percent CI, 0.50‒1.24), and angina (RR, 0.91, 95 percent CI, 0.55‒1.50; p=0.70).

“Antihypertensive drugs are one of the most effective strategies to prevent disability and mortality; however, there have been contradictory findings about the best dosing time for antihypertensive drugs,” the investigators said.