Evening dosing of antihypertensive drugs significantly reduced 24/48-hour SBP compared to morning dosing (MD 1.41 mm Hg; 95% CI 0.48-2.34), though this effect was mainly driven by one research group.
Meta-Analysis
Does evening dosing of antihypertensive drugs improve ambulatory blood pressure parameters and cardiovascular outcomes compared to morning dosing in patients on antihypertensive therapies?
Evening dosing of antihypertensives does not provide robust benefits over morning dosing for overall BP control or cardiovascular events when controversial trial data are excluded, suggesting dosing should be based on patient convenience.
Mean Difference: 1.41 (95% CI 0.48–2.34)
Background: The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening. Methods: A PubMed, EMBASE, and clinicaltrials.gov databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure (BP) parameters (day-time, night-time, and 24/48-hour systolic blood pressure SBP and diastolic blood pressure DBP) and cardiovascular outcomes. Results: Of 72 randomized controlled trials included, evening dosing significantly reduced ambulatory BP parameters: 24/48-hour SBP (mean difference MD=1.41 mm Hg; 95% CI, 0.48–2.34), DBP (MD=0.60 mm Hg 95% CI, 0.12–1.08), night-time SBP (MD=4.09 mm Hg 95% CI, 3.01–5.16), DBP (MD, 2.57 mm Hg 95% CI, 1.92–3.22), with a smaller reduction in day-time SBP (MD=0.94 mm Hg 95% CI, 0.01–1.87), and DBP (MD=0.87 mm Hg 95% CI, 0.10–1.63), and numerically lower cardiovascular events compared with morning dosing. However, when controversial data by Hermida (23 trials, 25 734 patients) were omitted ( P heterogeneity <0.05 for most outcomes), the above effect of evening dosing attenuated with no significant effect on 24/48-hour ambulatory blood pressure, day-time BP, and major adverse cardiac event and smaller reduction in night-time ambulatory SBP and DBP. Conclusions: Evening dosing of antihypertensive drugs significantly reduced ambulatory BP parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time BP, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects.
Maqsood et al. (Mon,) conducted a meta-analysis in Hypertension. Evening dosing of antihypertensive drugs vs. Morning dosing was evaluated on 24/48-hour systolic blood pressure (MD 1.41 mm Hg, 95% CI 0.48-2.34). Evening dosing of antihypertensive drugs significantly reduced 24/48-hour SBP compared to morning dosing (MD 1.41 mm Hg; 95% CI 0.48-2.34), though this effect was mainly driven by one research group.