Bedtime BP drugs best

Taking blood pressure tablets at night rather than in the morning significantly reduces cardiovascular events and mortality, according to a large study published in the European Heart Journal.

The Spanish primary-care-based study randomly assigned 19 084 hypertensive patients to take their daily dose of antihypertensive drugs at bedtime or on waking in the morning. The patients were followed up annually for just over six years.

Patients taking their antihypertensives in the evening had their risk of the combined primary endpoint of cardiovascular death, myocardial infarction, coronary revascularisation, heart failure, or stroke reduced by almost half (hazard ratio [HR] 0.55 [95% confidence interval (CI) 0.50–0.61]; p<0.001).

The individual components of the combined primary endpoint were also significantly reduced with evening dosing. The risk of cardiovascular death was more than halved (HR 0.44 [CI 0.34–0.56]), while the risk of myocardial infarction was reduced by a third (HR 0.66 [CI 0.52–0.84]) and the risk of stroke by 49% (HR 0.51 [CI 0.41–0.63]).

According to the authors: ‘This new trial is by far the largest ever conducted on the chronotherapy of hypertension and with the longest duration of follow-up. It was conducted at multiple primary care centres, and thus the results reflect what could be expected in routine clinical practice.’

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