Cleveland Clinic Journal of MedicineShould My Patients Take Their Blood Pressure Medications in the Evening to Enhance Cardiovascular Benefit? (CME)

Timing of Antihypertensive Medication Dosing: A Comprehensive Review of Current Evidence and Implications for Patient Care

The timing of antihypertensive medication dosing has been a topic of ongoing debate in the medical community. This article provides a comprehensive review of the current research, examining the potential benefits and risks associated with morning versus evening dosing. The findings underscore the importance of individualized patient care and shared decision-making in managing hypertension.

Key Points:

• Current evidence does not conclusively favor either morning or evening dosing of antihypertensive medications for cardiovascular benefit.
• Blood pressure follows a diurnal rhythm, generally lower at night (nocturnal dipping) and increasing in the morning.
• Patients with hypertension can be subdivided based on the nocturnal dipping pattern in systolic BP observed on 24-hour ambulatory monitoring.
• The MAPEC trial and the Hygia Chronotherapy Trial suggested potential benefits of evening dosing, but these findings have been questioned due to methodological concerns.
• The HARMONY trial and the TIME study found no significant difference between morning and evening dosing.
• Fall risk and glaucoma progression are potential concerns with evening dosing of antihypertensive medications.
• Shared decision-making is key, given the potential risks and benefits associated with different dosing times.

According to the World Health Organization, an estimated 46% of adults with hypertension are unaware that they have the condition.

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