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Morning vs Evening Administration of Antihypertensive Agents

Patients can take antihypertensive agents at the time of day most convenient for them and that minimizes adverse effects, authors conclude based on a study showing no difference between morning and evening administration. Whether evening dosing helps with nocturnal hypertension and cardiovascular outcomes has been controversial, and this study shows the time of day makes no difference. Home blood pressure measurements by participants showed that antihypertensive medications commonly used in the U.K. did not control blood pressure evenly over the 24-hour period between doses.

The Treatment in Morning versus Evening (TIME) study randomized 21,104 U.K. participants to morning or evening dosing groups of all their antihypertensive medications. The prospective, pragmatic trial used a composite primary endpoint of vascular death or hospitalization for nonfatal myocardial infarction or nonfatal stroke as identified by participant reports or in records in the National Health Service dataset. Over a median follow-up period of 5.2 years, the percentages of participants with a primary endpoint event were 3.4% and 3.7% with evening and morning administration, respectively. Several secondary outcomes (all-cause mortality, vascular death, hospitalization or death from congestive heart failure) were also statistically similar. The investigators identified no safety concerns.

“Blood pressure measurements by home blood pressure machines showed significant but small differences between the randomised dosing groups,” TIME investigators report. “Antihypertensive treatment regimens were prescribed for participants by their usual treating clinician, and we have no reason to believe that the choice of treatment was affected by participation in the trial. Therefore, these findings show that most antihypertensive agents prescribed in UK usual care do not lower blood pressure evenly over 24 h.”

Source: Lancet