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

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?