Is it better to take that antihypertensive at night?
A large RCT in a primary care setting comparing bedtime to upon-waking administration of antihypertensives answers the question.
PRACTICE CHANGER
Advise patients to take blood pressure (BP) medication at bedtime rather than upon waking because it results in a decrease in major cardiovascular disease events.
STRENGTH OF RECOMMENDATION
B: Based on a single, good-quality, multicenter trial.
Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial [published online ahead of print October 22, 2019]. Eur Heart J. 2019;ehz754. doi:10.1093/eurheartj/ehz754.1
CHALLENGES TO IMPLEMENTATION
Nighttime urination could lead to nonadherence
Taking diuretics at bedtime may result in unwanted nighttime awakenings for visits to the bathroom, which could lead to nonadherence in some patients.
ACKNOWLEDGMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
