Study Shows No Advantage of Nighttime Blood Pressure Medication Over Morning Dosing

In two trials involving frail elderly patients, taking blood pressure-lowering medications in the evening didn't offer any clinical benefits compared to taking them in the morning(14), according to new research presented at ESC Congress 2024.

In the BedMed trial, Canadian patients without glaucoma who were taking at least one daily blood pressure medication were randomly assigned to take their medications either in the morning or at bedtime(15). The main goal was to see if the timing affected major health problems like death, stroke, heart attack, or heart failure. Secondary goals included checking for unexpected hospital visits and issues related to vision, cognitive function, or fractures.

The BedMed-Frail trial was similar but focused on patients in Canadian long-term care facilities. These participants were assigned to either bedtime dosing or their usual morning dosing(15). Additional secondary goals included looking at skin ulcers and changes in cognitive function.

In the BedMed trial, 3,357 adults with an average age of 67 years (56% female) were randomly assigned to take their blood pressure medications either at bedtime or in the morning(16). There were no differences in safety outcomes or rates of hospitalizations and emergency department visits between the two groups.

In the BedMed-Frail trial, 776 participants with an average age of 88 years (72% female) were assigned to take their blood pressure medications either at bedtime or in the morning. Over an average of 415 days, major health problems occurred in 40.6% of those who took their medications at bedtime and in 41.9% of those who took them in the morning. There were no significant differences in other outcomes between the groups, except that taking medications at bedtime was associated with fewer unexpected hospital visits or emergency department trips.

Reference: The BedMed and BedMed-Frail randomised controlled trials - Effect of antihypertensive timing on mortality and morbidity’ will be discussed during Hot Line 2 on Saturday 31 August in room London.