Study compares benefits of taking antihypertensive medication in the morning or evening

Study compares benefits of taking antihypertensive medication in the morning or evening

A pragmatic randomized trial of more than 21,000 patients with hypertension followed for five years concluded that protection against heart attack, stroke and vascular death is not affected by whether antihypertensive medications are taken in the morning or evening. The current research will be presented today in a hotline session at the 2022 ESC Congress and contradicts previous findings that suggested a very large cardiovascular benefit from nighttime dosing.

More than a billion people worldwide suffer from high blood pressure. High blood pressure is the world's leading cause of premature death and was responsible for nearly ten million deaths in 2015, of which 4.9 million were due to ischemic heart disease and 3.5 million were due to stroke. Nocturnal blood pressure is a better predictor of cardiovascular outcomes than daytime blood pressure, and there is previous evidence that antihypertensive medications taken in the evening rather than in the morning reduce nocturnal blood pressure more. The Hygia study previously showed a protective effect of nighttime dosing on cardiovascular events, but that study has drawn criticism.

TIME was a large prospective, randomized trial conducted to test whether evening use of antihypertensive medications improved key cardiovascular outcomes compared to morning use.6 Adults who were taking at least one antihypertensive medication and had a valid email address were recruited through community advertising from primary and secondary care, as well as from databases admitted patients in the UK. After participants log on to 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 evening. The composite primary endpoint was hospitalization for nonfatal myocardial infarction or nonfatal stroke or vascular death in the intention-to-treat population. Information on hospitalizations and deaths was obtained from participants via email and by linking records to national databases, and further data were collected from GPs and hospitals and adjudicated independently by a committee blinded to the allocated dosing time.

A total of 21,104 patients were randomized, 10,503 received evening administration and 10,601 received morning administration. The average age of participants was 65 years, 58% were men and 98% were white. The median follow-up duration 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), yielding an unadjusted hazard ratio of 0.95 (95% confidence interval 0.83-1.10; p=0.53). Results did not differ in prespecified subgroup analyses. Taking medication in the evening was not harmful.

TIME was one of the largest cardiovascular studies ever conducted and provides a definitive answer to the question of whether antihypertensive medications should be taken morning or evening. The study clearly found that heart attack, stroke and vascular death occurred at similar rates 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 side effects.”

Thomas McDonald,Head of Studies, Professor,University of Dundee, UK

Source:

European Society of Cardiology (ESC)

.