Dosing Time for Daily BP Meds & CV Outcomes

Educational Objectives

Summary

Dosing Time for Daily Antihypertensive Medications Didn’t Affect Cardiovascular Outcomes

Blood pressure (BP) typically dips overnight and surges in the morning. Adverse cardiovascular (CV) events occur more frequently with the usual morning surge and in people who do not have usual diurnal BP variation. Two studies have reported a marked reduction in adverse CV events when antihypertensive medications are taken at night rather than in the morning (e.g., https://www.jwatch.org/na50538 and Eur Heart J 2020; 41:4565), but those trials have been controversial.

In a study in the October 22, 2022 issue of The Lancet (https://doi.org/10.1016/S0140-6736(22)01786-X), researchers in the United Kingdom randomized 21,000 adults with treated hypertension to take their usual daily medications either in the morning (between 6 AM and 10 AM) or at night (between 8 PM and midnight). Participants completed periodic online questionnaires about their adherence, medication side effects, and adverse CV events. CV events were verified using national hospitalization and death databases.

After median follow-up of 5 years, the morning and night dosing groups had similar rates of a composite CV outcome (i.e., CV-related death, nonfatal myocardial infarction, or stroke; 0.72 and 0.69 events per 100 patient-years, respectively) and a variety of secondary CV outcomes. Dizziness, indigestion, diarrhea, and myalgia occurred more commonly with morning dosing, whereas nocturia occurred more commonly with evening dosing. Using home monitors, patients assigned to morning dosing had slightly but significantly higher morning BPs and lower evening BPs than did patients assigned to evening dosing.

In this study, dosing in the morning or evening did not affect CV outcomes significantly; the results therefore suggest that patients may take their antihypertensive medications at the time of day that is most convenient for them. However, given the conflicting findings between this trial and previous trials that showed better outcomes with evening dosing, the controversy over optimal timing might not be over. Additional trials addressing this issue are being conducted in Canada (BedMed https://clinicaltrials.gov/ct2/show/NCT02990663 and BedMed-Frail https://clinicaltrials.gov/ct2/show/NCT04054648).

Bruce Soloway, MD

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Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Lecture ID:

JW332310

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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