Bedtime Hypertension Treatment More Effective Than Morning Treatment

Researchers have found that patients with high blood pressure (BP) who take all their antihypertensive medications at bedtime have better controlled blood pressure and a significantly lower risk of death or illness caused by heart or blood vessel problems, compared to patients who take their medications in the morning.¹

According to the CDC, about 75 million adults in the United States have high blood pressure, and only about 54% of them have the condition under control. High blood pressure increases risk for heart disease and stroke, which are leading causes of death in the United States.²

The Hygia Chronotherapy Trial, published in the European Heart Journal, evaluated 19,084 patients who were randomized to take their medications either upon waking or at bedtime. It was the largest trial to investigate the effect of the time of day when people take their antihypertensive medications, and it followed them for the longest length of time—averaging more than 6 years.¹ During that time, the patients' ambulatory blood pressure was checked over 48 hours at least once a year.¹

Researchers evaluated compliance with the prescribed BP-lowering treatment and schedule at each visit during follow-up. Poor adherence was reported as 2.8% for patients of the awakening regimen, and as 2.9% for patients on the bedtime regimen.¹ Adverse events were also registered at each visit, whether spontaneously reported by the patient or revealed through nondirect questioning and physical examination.¹

At the final evaluation, patients assigned to the bedtime-treatment regimen showed significantly lower creatinine and low-density lipoprotein cholesterol, as well as higher high-density lipoprotein cholesterol and estimated glomerular filtration rate.¹

During the median follow-up period of 6.3 years, 3246 participants had a listed registered cardiovascular disease (CVD) event. Of those patients, 1752 experienced myocardial infarction, coronary revascularization, heart failure, stroke, or CVD-related death. Patients taking their medications at night also had a substantial beneficial risk reduction for the secondary endpoints, including stroke, coronary events, and cardiac events.¹

While the Hygia Chronotherapy Trial does require validation and extrapolation to other ethnic groups, its findings corroborate the conclusions of previous randomized trials evaluating the effects of bedtime treatment against waking BP-lower treatment. Both studies' findings suggest that bedtime ingestion of anti-hypertensive medications is preferable in order to better control blood pressure.

REFERENCES

• Hermida RC, Crespo JJ, Dominguez-Sadina M, Otero A, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia CHronotherapy Trial. European Heart Journal. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478. Accessed October 23, 2019.
• CDC. About High Blood Pressure. CDC Website. cdc.gov/bloodpressure.about.htm. Accessed October 23, 2019.