Key result
Bedtime antihypertensive dosing lowers nighttime SBP by ~5 mmHg compared to morning administration.
Why the study?
Bedtime dosing of antihypertensives reduces nocturnal BP, but whether this effect is modified at the study level remains uncertain.
Does evening or bedtime administration of antihypertensive medications reduce nighttime ambulatory blood pressure in adult patients with hypertension compared to morning administration?
Meta-Analysis (n=29,654)
Does evening or bedtime administration of antihypertensive medications reduce nighttime ambulatory blood pressure in adult patients with hypertension compared to morning administration?
Bedtime dosing of antihypertensives significantly reduces nocturnal blood pressure compared to morning dosing, with the magnitude of benefit being highly dependent on the baseline prevalence of the non-dipper phenotype.
Bedtime dosing may improve nocturnal BP control; confirms chronotherapy benefit in Level 1 meta-analysis.
Bedtime dosing of antihypertensive medications is associated with a reduction in nocturnal blood pressure (BP), but whether this effect is modified at the study level remains uncertain. We conducted an updated meta-analysis of randomized controlled trials comparing bedtime versus morning antihypertensive administration, evaluating the overall treatment effect and its potential modification by baseline non-dipper prevalence. PubMed, EMBASE, and the Cochrane Library were searched, with nighttime ambulatory systolic BP (SBP) and diastolic BP (DBP) as primary outcomes. Subgroup analyses were performed based on baseline non-dipper proportion (< 60% vs. ≥ 60%). Sixty-six RCTs involving 29,654 participants were included. In the overall hypertensive population, bedtime dosing significantly reduced nighttime SBP (WMD: 4.87 mmHg; 95% CI: 3.75-6.00) and DBP (WMD: 2.80 mmHg; 95% CI: 2.23-3.37), with modest reductions in 24 h SBP (WMD: 2.06 mmHg) and daytime SBP (WMD: 0.99 mmHg). In trials restricted to non-dippers, a more pronounced reduction in nighttime BP was observed (SBP WMD: 7.57 mmHg; DBP WMD: 3.77 mmHg). Similarly, study populations with a higher baseline proportion of non-dippers (≥ 60%) experienced approximately two-fold higher nighttime SBP reductions versus those with lower prevalence (< 60%) (WMD: ∼9.7 vs. 4.4 mmHg; p < 0.01), with a consistent pattern for nighttime DBP (5.1 vs. 2.6 mmHg; between-group p < 0.05). Bedtime antihypertensive dosing reduces nocturnal BP across the general hypertensive population; however, the magnitude of effect appears to be modified at the study level by baseline non-dipper prevalence. These findings suggest that chronotherapy effects are heterogeneous across trial populations rather than uniform across all hypertensive individuals.
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Li et al. (2026) conducted a meta-analysis in Hypertension (n=29,654). Bedtime/evening administration of antihypertensive medications vs. Morning administration of the same antihypertensive medication(s) was evaluated on Mean change in nighttime ambulatory systolic blood pressure (SBP) from baseline (WMD 4.87 mmHg, 95% CI 3.75-6.00). Bedtime dosing of antihypertensive medications significantly reduced nighttime systolic blood pressure by a mean difference of 4.87 mmHg compared to morning dosing in the overall hypertensive population.
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