Abstract 4362312: The Effect of Bedtime vs. Morning Antihypertensive Treatment on Cardiovascular Events: Meta-Analysis

Background: Antihypertensive medications are essential for preventing cardiovascular events and have traditionally been administered in the morning. Recent studies have suggested that evening dosing may be more effective than morning dosing in reducing cardiovascular risk. Objective: This study aims to examine the association between dosing time and cardiovascular outcomes. Methods: A systematic literature review was performed to retrieve randomized controlled trials comparing morning and bedtime dosing of antihypertensives on cardiovascular events. The primary outcome was major adverse cardiovascular events (MACE), as defined by each study. The secondary outcomes included all-cause death, stroke, myocardial infarction, and heart failure. A random-effects model was applied for pooled analysis. Results: Seven randomized control trials with 63,459 participants (bedtime: 31,548, morning: 31,785) were included. The median follow-up period ranged from 1.1 to 6.3 years and the median age ranged from 55.6 to 80 years. We found no difference in MACE between the two groups (HR=0.81, 95% CI 0.61-1.08). Similarly, no between-group differences were found in all-cause death (HR=0.82, 95% CI 0.62-1.09), stroke (HR=0.86, 95% CI 0.58-1.28), myocardial infarction (HR=0.87, 95% CI 0.72-1.06), and heart failure (HR=0.71, 95% CI 0.43-1.18). Conclusion: No significant difference in cardiovascular outcomes was observed between morning and bedtime dosing of antihypertensive agents.