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