Taking Anti-Hypertension Medication at Bedtime Improves CVD Outcomes

Taking anti-hypertension medication before bedtime better controls blood pressure through the night and decreases the risk of cardiovascular disease (CVD)-related mortality or events, according to a study published in the European Heart Journal.

This multicenter, randomized, controlled, prospective clinical trial included 19,084 patients with hypertension (mean age, 60.5 years; 10,614 were male). Patients were randomized 1:1 to take their entire daily dose of one or more anti-hypertension medications at bedtime (n=9,552) or upon waking (n=9,532).

All patients wore ambulatory blood pressure (BP) measuring devices, which tracked BP 24 hours per day. At baseline and each scheduled clinic visit, ambulatory BP monitoring was performed for 48 hours.

Reduced risk of CVD outcomes with bedtime dosing

During a median follow-up of 6.3 years, 1,752 patients experienced a CVD outcome (primary endpoint): 274 had a heart attack, 302 had procedures to open clogged arteries, 521 were diagnosed with heart failure, 345 had a stroke, and 310 died from a cardiovascular cause.

Patients who took anti-hypertensive medications at bedtime were 45% less likely to die of cardiovascular causes overall, 56% less likely to die of CVD, 61% less likely to die of hemorrhagic stroke, and 46% less likely to die of ischemic stroke. These patients were also 34% less likely to have a heart attack, 40% less likely to need a procedure to widen clogged arteries, 42% less likely to develop heart failure, and 49% less likely to have a stroke.

After adjusting for age, sex, type 2 diabetes, chronic kidney disease, smoking, high-density lipoprotein cholesterol, asleep mean systolic BP, sleep-time relative systolic BP decline, and previous CVD event, patients who took their medications at bedtime had a significantly lower hazard ratio (HR) of the primary CVD outcome (HR=0.55; 95% CI, 0.50-0.61; P<0.001) and each of its single components: CVD death (HR=0.44; 95% CI, 0.34-0.56), myocardial infarction (HR=0.66; 95% CI, 0.52-0.84), coronary revascularization (HR=0.60; 95% CI, 0.47-0.75), heart failure (HR=0.58; 95% CI, 0.49-0.70), and stroke (HR=0.51; 95% CI, 0.41–0.63; P<0.001 for all).