Timing of blood pressure medication administration does not affect outcomes

Night administration of blood stress (BP)-lowering drugs didn’t scale back the danger of cardiovascular occasions or dying in contrast with morning administration, in accordance with late-breaking analysis introduced in a Scorching Line session in the present day at ESC Congress 2024.

Proof means that higher-than-normal ranges of BP at evening are related to an elevated threat of cardiovascular occasions. Nonetheless, trials which have assessed the influence of administering BP-lowering drugs at evening have proven blended outcomes. On this meta-analysis, we gathered collectively the entire trial information and concluded that the timing of dosing doesn’t have an effect on outcomes.”

Professor Ricky Turgeon, examine presenter from the College of British Columbia, Vancouver, Canada

A scientific overview and meta-analysis was undertaken that included all parallel-group randomized managed trials (RCTs) evaluating night-time and morning administration of all BP-lowering drugs. Research needed to have a minimum of one cardiovascular end result of curiosity, with follow-up of ≥500 patient-years per group and median follow-up ≥12 months. Trials have been assessed utilizing the Cochrane Threat of Bias 2 instrument.

The first endpoint was main hostile cardiovascular occasions (MACE, a composite of dying from any trigger, non-fatal myocardial infarction, non-fatal stroke and coronary heart failure exacerbation). Secondary endpoints included particular person elements of MACE, all-cause hospitalization and particular security occasions (fractures, glaucoma-related occasions and worsening cognition).

5 RCTs have been included with 46,606 sufferers – BedMed,2 BedMed-Frail,2 TIME,3 Hygia4 and MAPEC.5 The BedMed, BedMed-Frail and TIME trials have been judged to be at general low threat of bias, whereas there have been some bias considerations with Hygia and MAPEC, notably relating to the randomization course of.

Throughout the 5 trials, the incidence of MACE was not affected by night vs. morning dosing (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.43-1.16). In a sensitivity evaluation by threat of bias, the HR was 0.94 (95% CI 0.86-1.03) for MACE with night vs. morning dosing within the three trials judged to have low bias and 0.43 (95% CI 0.26-0.72) within the two trials with bias considerations.

There was no distinction in all-cause mortality for night and morning dosing (HR 0.77; 95% CI 0.51-1.16). Equally, all different secondary endpoints weren’t affected by night vs. morning dosing, together with for fractures, glaucoma occasions and cognitive occasions.

“Outcomes from the meta-analysis present conclusive proof that there is no such thing as a distinction between night and morning dosing. Sufferers ought to take their once-daily BP-lowering drugs at no matter time most closely fits their preferences and circumstances,” concluded Professor Turgeon.