Patient preference may be the most important thing when it comes to timing their intake, promising safety and efficacy data suggests.
Patients who take their blood pressure medication at night have no greater health risks than those who take it in the morning, according to new Canadian research.
The findings suggest patient preference can play more of a role in when the medicines are taken, overturning the conventional morning approach.
The researchers randomly assigned more than 3300 Canadian primary care patients with hypertension to receive their BP medicine at either bedtime or in the morning.
“Bedtime administration of antihypertensive medications was safe but did not reduce cardiovascular risk,” the authors wrote in JAMA.
The primary outcome, which was the time to first occurrence of all-cause death or hospitalisation/emergency department visit for stroke, acute coronary syndrome or heart failure, was no different between groups.
In the 4.6 year follow up period, these events occurred in 2.3 per 100 patient-years for the bedtime group and 2.4 per 100 patient-years in the morning group.
Moreover, both groups had the same rates of visual, cognitive, fall- and fracture-related adverse events.
“Antihypertensive medication administration time did not affect the risks and benefits of BP-lowering medication and instead should be guided by patient preferences,” the researchers wrote.
The trial, known as the BedMed study, undermines fears that taking the drugs at night increases the risk of glaucoma, and further supports several recent large-scale findings that bedtime administration is safe.
“To our knowledge, BedMed is the first RCT to examine the effect of bedtime antihypertensive use on cognition, new glaucoma diagnosis and subjective visual deterioration,” the researchers wrote.
However, adherence was slightly lower in the bedtime group, with 83% taking the drugs as assigned by six months, compared with 95% of the morning group for those who took the tablets once daily.
“Adherence to allocation decreased gradually with time, but at 72 months, when at its lowest, one or more once-daily antihypertensive was still taken per allocation by 70% of bedtime and 88% of morning participants,” they wrote.
Patients taking diuretics were more likely to report nocturia.
Around half of the participants were taking monotherapy, and the proportion of participants who took each antihypertensive was: 36% for angiotensin-converting enzyme inhibitors, 30% for angiotensin receptor blockers, 29% for calcium channel blockers, 27% for diuretics, 18% for combination pills, 17% for β-blockers and 1% took other agents. The average median age of participants was 67; 18% of participants had diabetes, 11% had known coronary artery disease and 7% had chronic kidney disease.
