RCT: Bedtime vs Morning Dosing for Antihypertensive Medications?
BACKGROUND AND PURPOSE:
Nocturnal hypertension is a predictor of cardiovascular risk and is the basis for the hypothesis that taking antihypertensive drugs in the evening would be beneficial
Mackenzie et al. (The Lancet, 2022) compared antihypertensive medication dosing in the evening vs the morning to determine if there is a cardiovascular benefit
Prospective, pragmatic, randomized, parallel-group study
Treatment in Morning versus Evening (TIME) study
Taking ≥1 antihypertensive medication
Morning group: Usual antihypertensive medications in the morning (0600 to 1000 h)
Bedtime group: Usual antihypertensive medications in the evening (2000 to 0000 h)
The primary outcome was assessed in the intention to treat population
Safety was assessed in all participants who submitted ≥1 follow-up questionnaire
Composite of vascular death or hospitalization for non-fatal myocardial infarction or non-fatal stroke
Morning: 10,601 participants | Bedtime: 10,503
Mean age 65.2 (SD, 9.3) years
White: 90.5% | Black: 0.5% | Not reported: 7.8%
Previous cardiovascular disease: 13.0%
Median follow-up: 5.2 (IQR, 4.9 to 5.7) years
There was no difference in the rate of primary outcome occurrence between the groups
Rate: 0.69 events (95% CI, 0.62 to 0.76) per 100 patient-years
Rate: 0.72 events (95% CI, 0.65 to 0.79) per 100 patient-years
Hazard ratio 0.95 (95% CI, 0.83 to 1.10); P=0.53
There were no safety concerns
There was no difference in major adverse cardiovascular events based on the time of day at which patients took their antihypertensive medication
The authors state
Therefore, patients should be advised that they need not change their antihypertensive medication dosing time but might choose to take their medication at a time that suits them best, because the timing makes no difference to cardiovascular outcomes
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