Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis

Abstract

Background: The risk of cardiovascular and cerebrovascular events is the highest during the first several hours post-awakening in patients with hypertension. This is largely due to surges in morning blood pressure (BP). The current meta-analysis explored whether morning BP is affected by the timing of antihypertensive drug administration.Methods: Four medical databases were searched for clinical trials that examined the relationship between the timing of antihypertensive drug administration and morning BP levels. This meta-analysis compared morning BP surges in patients administered medication at bedtime versus patients administered medication during the day. Results:The random effects model demonstrated that bedtime administration of antihypertensive drugs reduced morning systolic blood pressure (SBP) by 1.17 mmHg [with 95% confidence interval (CI): −2.47 to 0.37; P=0.08), and reduced morning diastolic blood pressure (DBP) by 0.95 mmHg (95% CI: −2.03 to 0.13; P=0.08), compared with patients who were administered medication during the daytime hours. However, the results did not demonstrate statistical significance. There was strong heterogeneity in both morning SBP (I 2 =77.9% >50%, and Q test >0.1) and morning DBP results (I 2 =77.9% >50%, and Q test >0.1). The funnel plots showed no publication bias in this study.Discussion: Studies have shown that a 1 mmHg change was sufficient to reduce the risk of cardiovascularrelated deaths by 2.1%. Therefore, changing the time of taking antihypertensive medications may significantly reduce cardiovascular-associated mortality. There were certain limitations to this meta-analysis.First, the heterogeneity of the meta-analysis was strong, with undefined reasons. Second, the sample size was relatively small, and future studies involving larger cohorts are warranted to further assess the effects of bedtime antihypertensive medication on minimizing morning BP surges.

Effect of administration of low‐dose irbesartan and hydrochlorothiazide combined with levamlodipine at different times on the circadian rhythm of blood pressure and the levels of MMPs and TIMPs in non‐dipper patients with grade 1 and 2 hypertension

“…adopted a chronotherapeutic protocol to treat NDH, which reduced blood pressure and effectively corrected the “non‐dipper” curve of blood pressure, with significant patient benefit. In a meta‐analysis, Jiang 26 et al. reported that bedtime administration of antihypertensive drugs reduced dSBP by 1.17 mmHg and cardiovascular‐related mortality by 2.1%.…”

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

“…Still, we could not find a significant association of dipping patterns with E-selectin. The time of day when antihypertensive drugs are taken plays a significant role in nocturnal BP fall [ 62 ] and this might have influenced our results. Additionally, another explanation is the use of certain antihypertensive drugs such as long-acting calcium channel blockers and angiotensin II-receptor blockers which have been shown to decrease E-selectin levels [ 63 , 64 ].…”

Prevalence and Clinical Characteristics including Patterns of Antihypertensive Drug Administration of the Different Home Blood Pressure Phenotypes in Treated Hypertensive Patients

“…For EHT and MoEHT groups, the independently associated clinical factor was taking at least 1 long-acting antihypertensive drug once daily in the morning. Antihypertensive drugs were an important factor in home BP control since previous studies of chronotherapy of hypertension indicated that evening or bedtime administration of antihypertensive drugs improved morning BP control [36][37][38]. Because of the long duration of action of antihypertensive drugs that were taken in the morning, the evening home BP was controlled to achieve the BP target.…”