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Evidence summaries

Evening Versus Morning Dosing of Antihypertensive Drugs

Evening dosing with antihypertensive drugs may have a slightly better blood pressure control than morning dosing in 24-hour blood pressure, but the clinical significance and its effect on death and adverse cardiovascular outcomes is not known. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (lack of allocation concealment and selective outcome reporting) and by inconsistency (variability in results).

Summary

A Cochrane review [Abstract] 1 included 21 studies with a total of 1 993 subjects with primary hypertension. The studies compared once-daily administration of antihypertensive drug (ACEIs in 5 studies, CCBs in 7 studies, ARBs in 6 studies, diuretics in 2 studies, alpha-blockers in 1 studies, and beta-blockers in 1 study) at night (6 p.m. to midnight) or in the morning (6 a.m. to noon).

Evening regimen reduced 24-hour systolic blood pressure (SBP) by -1.71 mmHg (95% CI -2.78 to -0.65, statistical heterogeneity I2 =85%, 21 studies, n=2 152) and diastolic blood pressure (DBP) by -1.38 mmHg (95% CI -2.13 to -0.62; statistical heterogeneity I2 =85%, 21 studies, n=2 158). No significant differences were noted for morning SBP (-1.62 mmHg, 95% CI -4.19 to 0.95; statistical heterogeneity I2 =59%, 3 studies, n=391) and morning DBP (-1.21 mmHg, 95% CI -3.28 to 0.86; I2 =66%, 3 studies, n=391) between evening dosing and morning dosing. No RCT reported on all cause mortality, cardiovascular mortality, cardiovascular morbidity and serious adverse events.There was no statistically significant difference for overall adverse events (RR 0.78, 95%CI 0.37 to 1.65, statistically significant heterogeneity I2 =59%, 5 studies, n=702) and withdrawals due to adverse events (RR 0.53, 95%CI: 0.26 to 1.07, 6 studies, n=1042) between evening and morning dosing.

Clinical comments

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References

  • Zhao P, Xu P, Wan C et al. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2011;(10):CD004184. [PubMed]

Primary/Secondary Keywords