Bedtime antihypertensive dosing shows no cardiovascular benefit over morning dosing

BACKGROUND: Antihypertensive medications are essential for preventing cardiovascular events and have traditionally been taken in the morning. However, recent studies have suggested that taking the medication at bedtime may be more effective in reducing cardiovascular risk. This study aimed to examine the association between dosing time and cardiovascular outcomes. METHODS: Randomized controlled trials were retrieved through a systematic literature review using PubMed and Embase. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause (or cardiovascular) death, myocardial infarction, stroke, and hospitalization for heart failure. Secondary outcomes included each component of the primary outcome. A random-effects model was applied to calculate the pooled hazard ratio (HR) for each outcome. RESULTS: Five randomized controlled trials with 46,477 participants (bedtime, 23,178; morning, 23,299) were included. The median follow-up period ranged from 1.1 to 6.3 years, and the mean or median age ranged from 55.6 to 88 years. We found no evidence that bedtime antihypertensives administration was associated with the risk of MACE [HR = 0.71; 95% confidence interval (CI), 0.43-1.16], all-cause death (HR = 0.76; 95% CI, 0.49-1.17), stroke (HR = 0.70; 95% CI, 0.39-1.23), myocardial infarction (HR = 0.88; 95% CI, 0.56-1.38), or hospitalization for heart failure (HR = 0.58; 95% CI, 0.26-1.33), compared to morning administration. CONCLUSIONS: Administration of antihypertensives at bedtime was not significantly associated with a lower incidence of cardiovascular outcomes in comparison with administration in the morning.