Evening dosing of antihypertensives provided significantly greater reductions in 24-hour systolic (WMD 2.06 mmHg) and diastolic (WMD 0.69 mmHg) blood pressure compared to morning dosing.
Meta-Analysis
Does bedtime administration of antihypertensive medication improve ambulatory blood pressure control and clinical outcomes compared to morning dosing in hypertensive adults?
Bedtime dosing of antihypertensive medications provides superior ambulatory BP control, particularly for nighttime BP, and is associated with reduced cardiovascular risk compared to morning dosing.
Mean Difference: 2.06
Objective: To determine whether bedtime administration of antihypertensive medication provides superior ambulatory blood pressure (BP) control and improved clinical outcomes compared to morning dosing.Design and method: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bedtime versus morning dosing in hypertensive adults. Primary outcomes were changes in ambulatory BP parameters. Results: Sixty-nine RCTs were included. In the overall population, evening dosing provided significantly greater reductions in 24-hour (SBP WMD: 2.06 mmHg; DBP WMD: 0.69 mmHg), daytime (SBP WMD: 0.99 mmHg; DBP WMD: 0.68 mmHg), and nighttime BP (SBP WMD: 4.87 mmHg; DBP WMD: 2.80 mmHg) compared to morning dosing. In non-dipper patients, evening dosing significantly improved only nighttime BP (SBP WMD: 7.57 mmHg; DBP WMD: 3.77 mmHg). For clinical events, evening dosing was associated with significantly lower risks of all-cause mortality (OR=1.50), cardiovascular mortality (OR=2.32) and MACE (OR=1.72). Subgroup analyses revealed that the BP-lowering efficacy of evening dosing was significantly influenced by the type of ambulatory BP monitoring device used, with attenuated effects observed in studies utilizing a unified model. Furthermore, a higher baseline prevalence of non-dipper status was a key modifier, associated with a markedly greater reduction in nighttime BP with evening dosing. Conclusions: Evening dosing provides superior ambulatory BP control, particularly for nighttime BP in non-dippers, and is associated with reduced cardiovascular risk. The effect is modified by technical factors and patient characteristics, highlighting the importance of personalized therapy.
Zhou et al. (2026) conducted a meta-analysis in Hypertension. Bedtime administration of antihypertensive medication vs. Morning dosing was evaluated on Changes in ambulatory BP parameters (24-hour SBP) (WMD 2.06). Evening dosing of antihypertensives provided significantly greater reductions in 24-hour systolic (WMD 2.06 mmHg) and diastolic (WMD 0.69 mmHg) blood pressure compared to morning dosing.