Should blood pressure medications be taken at bedtime?
Published Jan 28, 2020 · C. Heneghan, J. O’Sullivan, K. Mahtani
BMJ Evidence-Based Medicine
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Abstract
Hypertension is a common problem that increases cardiovascular risk. A recent large trial suggests the timing of treatment can make a difference to outcomes . Accumulating evidence shows that the time of day that antihypertensives are taken can impact their effectiveness: taking them at night reduces asleep blood pressure (BP), without compromising their effect on daytime BP.1 Asleep BP is also a better predictor of cardiovascular risk than daytime measurements and non-dipping during sleep, defined as a decline of less than a 10% in systolic pressure, is associated with an increased cardiovascular risk.2 In 2010, a randomised trial including 2156 hypertensives, taking ≥1 BP-lowering medication at bedtime, reported significant reductions in night-time BP and cardiovascular events at a mean 5.6 years of follow-up.3 However, the generalisability of the trial findings was limited by the single-centre design and the small sample size of the study. Replication of these findings in a much larger primary care population was therefore needed. The Hygia Chronotherapy Trial sought to address this evidence gap. The study randomised 19 084 primary care patients, across a …