Randomized Crossover Trial of the Impact of Morning or Evening Dosing of Antihypertensive Agents on 24-Hour Ambulatory Blood Pressure
Why the study?
Does morning versus evening dosing of antihypertensive agents improve 24-hour ambulatory blood pressure in patients with reasonably controlled hypertension?
Population
103 patients aged 18 to 80 years with reasonably controlled hypertension on stable therapy of ≥1…
Comparison
Usual antihypertensive therapy administered in… vs Usual antihypertensive therapy administered in…
Design
RCT, Randomized crossover design
Follow-up
24 weeks (12 weeks per crossover period)
Authors
Discussion
Loading...
Member takes
Implication
Supports flexible dosing timing without compromising control; reinforces that evening administration offers no ambulatory BP advantage in controlled hypertension.
Key Points
- To evaluate whether morning versus evening dosing of antihypertensive medications affects 24-hour ambulatory and clinic blood pressure levels in patients with well-controlled hypertension.
- Randomized crossover trial (N=103; mean age 62; 44% female; NCT01669928) conducted across two centers in London and Thessaloniki in patients with controlled hypertension (≤150/≤90 mm Hg) on stable therapy.
- Participants were randomized to take usual therapy in the morning (6 am–11 am) or evening (6 pm–11 pm) for 12 weeks, followed by a crossover to the alternative schedule for an additional 12 weeks.
- Clinic and 24-hour ambulatory blood pressure were recorded at baseline, 12 weeks, and 24 weeks, evaluated with a 2-level hierarchical regression model adjusted for center, period, and sequence.
- A total of 95 of 103 patients (92%) completed all three 24-hour ambulatory blood pressure recordings.
- Mean 24-hour systolic and diastolic blood pressure did not differ between daytime and evening drug dosing regimens.
- No differential impact was observed on daytime (7 am–10 pm), nighttime (10 pm–7 am), or clinic blood pressure levels, with consistent results across age and sex subgroups.
Structured PICO
Does morning versus evening dosing of antihypertensive agents improve 24-hour ambulatory blood pressure in patients with reasonably controlled hypertension?
P
Population
103 patients aged 18 to 80 years with reasonably controlled hypertension (≤150/≤90 mm Hg) on stable therapy of ≥1 antihypertensive agent, mean age 62, 44% female, recruited from 2 centers in London and Thessaloniki.
I
Intervention
Usual antihypertensive therapy administered in the morning (6 am-11 am) for 12 weeks.
C
Comparator
Usual antihypertensive therapy administered in the evening (6 pm-11 pm) for 12 weeks (crossover design).
O
Outcome
Mean 24-hour systolic blood pressure.surrogate
In patients with reasonably controlled hypertension, the timing of antihypertensive drug administration (morning vs. evening) does not significantly affect 24-hour or clinic blood pressure levels.
Cite This Study
Poulter et al. (2018) studied this question.