This article is more than 5 years old. Information may no longer be current.
Antihypertensives at bedtime confer improved BP control vs. morning medications
Click Here to Manage Email Alerts
Patients with hypertension who took BP-lowering medications at bedtime had improved ambulatory BP control compared with those who took medications when they woke up, which led to a reduction in major CVD events, according to a study published in the European Heart Journal.
“Results indicate lower risk of major cardiovascular events and stroke when hypertension medications are ingested at bedtime rather than upon awakening,” Ramón C. Hermida, PhD, director of bioengineering and chronobiology labs at the University of Vigo in Spain, told Cardiology Today. “Furthermore, patients ingesting medications at bedtime also showed at the end of the study improved renal function and lipid profile, all of these known markers of cardiovascular risk.”
Researchers analyzed data from 19,084 patients (mean age, 61 years; 56% men) from Spain with hypertension who were assigned to take one or more BP-lowering medications either at bedtime (n = 9,552) or upon awakening (n = 9,532). Medications included angiotensin II receptor antagonists, ACE inhibitors, calcium channel blockers, beta-blockers and/or diuretics.
Follow-up was conducted annually for a median of 6.3 years.
“This new trial is by far the largest ever conducted on the chronotherapy of hypertension and with the longest duration of follow-up,” Hermida said in an interview. “It was conducted at multiple primary care centers and, thus, results somehow reflect what could be expected in routine clinical practice.”
Ambulatory BP was monitored for 48 hours at follow-up.
“Asleep systolic blood pressure mean, and not office BP measurements, is the most significant marker of cardiovascular risk and can only be determined by around-the-clock ambulatory BP monitoring,” Hermida told Cardiology Today.
The primary CVD outcome was coronary revascularization, MI, ischemic stroke, HF, hemorrhagic stroke and CVD death.
During follow-up, the main CVD outcome occurred in 1,752 patients.
Compared with patients assigned medication upon awakening, those assigned medication at bedtime had a lower HF of the primary CVD outcome after adjustment for sex, age, chronic kidney disease, type 2 diabetes, HDL, smoking, asleep systolic BP, previous CVD event and sleep-time relative systolic BP decline (HR = 0.55; 95% CI, 0.5-0.61). This was also seen for single components of the primary outcome including MI (HR = 0.66; 95% CI, 0.52-0.84), CVD death (HR = 0.44; 95% CI, 0.34-0.56), HF (HR = 0.58; 95% CI, 0.49-0.7), coronary revascularization (HR = 0.6; 95% CI, 0.47-0.75) and stroke (HR = 0.51; 95% CI, 0.41-0.63).
“Among patients with true hypertension diagnosed on the basis of ambulatory BP monitoring, as now recommended, ingesting their antihypertensive medications at bedtime increases blood pressure control and markedly reduces cardiovascular morbidity and mortality,” Hermida said in an interview. “However, patients undergoing treatment must consult their physicians before doing any change in treatment, including the time of ingestion. It would preferably be recommended, first, to perform ambulatory BP monitoring to ascertain if the individual is indeed hypertensive and evaluate the need for treatment.” – by Darlene Dobkowski
For more information:
Ramón C. Hermida, PhD, can be reached at rhermida@uvigo.es.
Disclosures: The authors report no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts