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#Grand Rounds

Hygia Chronotherapy Trial Results: Is it Better to Take Blood Pressure Medications at Night?

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BACKGROUND AND PURPOSE:

  • Previous research has demonstrated BP improvement when medications are taken at night rather than during the day
  • Hermida et al. (European Heart Journal, 2019), sought to evaluate if bedtime medication also impacted cardiovascular disease (CVD) risk

METHODS:

  • Multicenter, controlled, randomized trial (RCT)
    • Hygia Chronotherapy Trial: Network of 40 primary care centers in Northern Spain
  • Participants with confirmed hypertension diagnosis
    • SBP means: Awake ≥135 mmHg | Asleep ≥120 mmHg
    • DBP means: Awake ≥85 mmHg | Asleep ≥70 mmHg
    • On medications to control BP (ARB, ACEI, CCB, β-blocker, and/or diuretic)
  • Interventions
    • Bedtime dosing: All medications at bedtime
    • Daytime dosing: All medications upon awakening
  • Study design
    • Ambulatory blood pressure (ABP) monitoring for 48 h at inclusion and at every scheduled clinic visit
    • Hazard ratio (HRs) adjusted to address confounders
  • Primary outcome
    • Major CVD event: CVD death | MI | Coronary revascularization | Heart failure | Stroke)

RESULTS:

  • 19,084 hypertensive patients were included | Follow-up 6.3 year median | 1752 participants experienced a major CVD event
    • 10,614 men/8470 women | 60.5 ± 13.7 years of age
    • Bedtime group: 9552
    • Awakening group: 9532
  • Bedtime group had a lower risk of
    • Major CVD event (P<0.001): HR 0.55 (95% CI, 0.50 to 0.61)
    • CVD death (P < 0.001): HR 0.44 (95% CI, 0.34 to 0.56)
    • Myocardial infarction (P < 0.001): HR 0.66 (95% CI, 0.52–0.84)
    • Coronary revascularization (P < 0.001): HR 0.60 (95% CI, 0.47 to 0.75)
    • Heart failure (P < 0.001): HR 0.58 (95% CI, 0.49 to 0.70)
    • Stroke (P < 0.001): HR 0.51 (95% CI, 0.41–0.63)
  • There were no differences in adverse events between groups

CONCLUSION:

  • Patients that took their hypertension medications at bedtime vs upon awakening had not only better BP control, but had lower risk for major CVD events
  • Limitations of the study include
    • Restriction to Caucasians and therefore further studies need to be performed to determine generalizability to other populations
    • Clinicians chose medications, although one of the strengths of the study is that results reflect actual practice  

Learn More – Primary Sources:

Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial

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Related ObG Topics:

Automated BP Cuffs, Home Monitoring and Hypertension Definitions
ACC/AHA Blood Pressure Guideline: New Classification System and Treatment Targets
ACC/AHA Blood Pressure Treatment Guideline: Lifestyle Modification and Drug Therapy
How Does Exercise Compare to Hypertension Drugs to Treat High Blood Pressure?
Results of the TASMINH4 Study: Does Self-Monitoring Blood Pressure Lead to Better Hypertension Outcomes?

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