Evening dosing of blood pressure medications is no better than morning dosing
The TIME essay presented at the ESC 2022 Congress
A pragmatic randomized trial in more than 21,000 patients with high blood pressure followed for more than five years concluded that protection against heart attacks, strokes, and vascular death is not affected whether antihypertensive medications are taken in the morning or evening. The breaking research was presented in a Hot Line session at the 2022 ESC Congress and contradicts previous findings that suggested a large cardiovascular benefit from nocturnal dosing.
More than one billion people have high blood pressure worldwide. High blood pressure is the leading global cause of premature death, with almost ten million deaths in 2015, of which 4.9 million were due to ischemic heart disease and 3.5 million to strokes.
Nighttime blood pressure is a better predictor of cardiovascular outcomes than daytime blood pressure, and there is prior evidence that antihypertensive medications taken at night rather than in the morning reduce nighttime blood pressure to a greater extent. The Hygia study previously indicated a protective effect of nighttime dosing on cardiovascular events, but this study has drawn criticism.
TIME was a large prospective randomized trial conducted to evaluate whether evening dosing of antihypertensive medications improved major cardiovascular outcomes compared with morning dosing .
Adults taking at least one antihypertensive medication and with a valid email address were recruited through community advertising, primary and secondary care, and consented patient databases in the United Kingdom. After participants registered on the TIME website (http://www.timestudy.co.uk) and their eligibility was confirmed, they were randomized 1:1 to take their usual antihypertensive medication in the morning or in the evening. the night .
The primary composite endpoint was hospitalization for nonfatal myocardial infarction or nonfatal stroke, or vascular death, in the intention-to-treat population.
A total of 21,104 patients were randomized , 10,503 to the evening dose and 10,601 to the morning dose. The average age of participants was 65 years , 58% were men, and 98% were white. The median duration of follow-up was 5.2 years , but some were in the study for more than nine years.
The primary endpoint occurred in 362 (3.4%) participants in the evening dosing group (0.69 events per 100 patient-years) and 390 (3.7%) in the morning dosing group (0.72 events per 100 patient-years), giving an unadjusted hazard ratio of 0.95 (95% confidence interval 0.83-1.10; p=0.53).
Results did not vary in prespecified subgroup analyses. Taking medication at night was not harmful.
Lead researcher Professor Thomas MacDonald from the University of Dundee, UK, said: “TIME was one of the largest cardiovascular studies ever carried out and provides a definitive answer to the question of whether blood pressure lowering drugs should be taken. in the morning or at night. The trial clearly found that heart attack, stroke and vascular death occurred to a similar degree, regardless of the timing of administration. “People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them and minimizes any undesirable effects.”
