medwireNews: A large randomized trial may have settled the question of whether it is best to take blood pressure medications in the morning or evening.
The Hygia Chronotherapy Trial, published in the European Heart Journal, shows that taking medications in the evening not only improved participants’ blood pressure, but also resulted in them having significantly fewer cardiovascular (CV) events over a median 6.3 years of follow-up. Around a quarter of the participants had type 2 diabetes.
The 9552 patients who took their medications in the evening had significantly lower nighttime blood pressure than the 9532 assigned to take their medications in the morning (systolic=114.7 vs 118.0 mmHg), but there was no difference during the day. Because of this, 37% of the evening medication group had a high-risk “non-dipper” blood pressure pattern, compared with 50% of the morning medication group.
This was reflected in hard CV outcomes, with a significant 45% relative risk reduction for myocardial infarction, coronary revascularization, heart failure, stroke, or CV disease death for the evening versus morning medication group.
Ramón Hermida (University of Vigo, Spain) and study co-authors conducted the trial in a real-world primary care setting, allowing physicians to prescribe whichever medications they felt to be appropriate.
However, in a press statement, independent expert Stephen MacMahon (The George Institute for Global Health, Sydney, Australia) highlighted the large effect on CV outcomes despite the relatively small effect on nighttime blood pressure.
“These effects are larger than the long-established effects of taking any blood pressure lowering treatment whatsoever, which is difficult to reconcile,” he said.
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