Bedtime ingestion of hypertension medications substantially enhances lowering of asleep BP and markedly reduces cardiovascular disease morbidity and mortality compared to ingestion upon waking.
Does bedtime administration of hypertension medications reduce cardiovascular disease morbidity and mortality in patients with true arterial hypertension compared to morning administration?
Bedtime administration of hypertension medications improves asleep blood pressure control and reduces cardiovascular morbidity and mortality compared to morning dosing.
INTRODUCTION: Hypertension guidelines do not recommend the time to administer blood pressure (BP)-lowering medications, despite multiple prospective clinical trials reporting both improved normalization of BP 24 h patterning and reduced cardiovascular disease (CVD) events when ingested at bedtime rather than upon awakening. AREAS COVERED: We review: (i) circadian rhythm-dependent influences on the pharmacokinetics (PK) and pharmacodynamics (PD) of hypertension medications; (ii) reports of ingestion-time differences in PK and PD of such therapies; and (iii) (chrono)prevention of CVD morbidity and mortality achieved by the simple and low-cost bedtime hypertension chronotherapy strategy, i.e. scheduling at bedtime ≥1 conventional BP-lowering medications to target asleep BP control of ABPM-diagnosed true arterial hypertension patients. EXPERT OPINION: Proper management of hypertension requires awareness of known ingestion-time differences in both the PK of individual BP-lowering medications and their combinations, which arise from circadian rhythms affecting absorption, distribution, metabolism, and elimination, and their PD, which result from circadian rhythms in mechanisms that regulate the 24 h BP pattern. The vast majority of the multiple published trials document substantially enhanced lowering of asleep BP, increased sleep-time relative BP decline (dipping), and markedly better reduction of CVD morbidity and mortality when hypertension medications and their combinations are ingested at bedtime rather than upon waking.
Hermida et al. (Thu,) conducted a review in Hypertension. Bedtime ingestion of hypertension medications vs. Ingestion upon waking was evaluated on Cardiovascular disease morbidity and mortality and asleep BP control. Bedtime ingestion of hypertension medications substantially enhances lowering of asleep BP and markedly reduces cardiovascular disease morbidity and mortality compared to ingestion upon waking.