No Difference in Antihypertensive Medication Dosing in Morning vs Evening

Vasodilating drug for heart and blood vessels. Packing of pills with inscription “Antihypertensive Medication” for treatment of cardiovascular diseases is at doctor cardiologist near EKG stethoscope
Researchers reported their findings on the effects of antihypertensive dosing in morning vs evening on patient prognosis at AHA 2021.

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Taking antihypertensive medication in the morning vs evening does not have a significant effect on prognosis for individuals with hypertension, though taking doses both in the morning and evening is associated with increased risk for mortality, according to study results presented at AHA 2021, held from November 13 to 15, 2021.

This study included 26,751 deceased individuals with hypertension, all of whom were enrolled in the Spanish ABPM Registry and had both cardiovascular death and vital status records available. The mean age of this population was 62 years old and consisted of 60% men. Hazard ratio (HR) calculations were performed by treatment administration using Cox models with adjustments for 24-hour systolic blood pressure and clinical confounders.

The majority (76.7%) of the study population took medication in the morning (mortality 13.7 per 1000 patients/year), 13% took it in the evening (mortality 17.8), and 10.3% adhered to a multiple-dose schedule in both the morning and evening (mortality 21.8). Those taking their medication in the evening were not at a significantly higher risk compared with the morning group in terms of total mortality (HR 1.06; 95% CI, 0.93-1.21) or cardiovascular mortality (HR 1.15; 95% CI, 0.93-1.41). Those on a morning-evening schedule were at greater risk for total mortality (HR 1.29; 95% CI, 1.14-1.48) and cardiovascular mortality (HR 1.46; 95% CI, 1.18-1.80), with similar results yielded by additional analyses with double-robust propensity scores.

The study authors concluded that “morning or bedtime dosing of the antihypertensive medication has no effect on prognosis,” and that those “receiving their medication in a multiple schedule, including morning and evening dosing, have an increased risk of mortality and cardiovascular mortality, even after adjustment for confounders.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


De La Sierra A, Ruilope LM, Martinez-Camblor P, et al. Evening dosing of antihypertensive treatment is not associated with a better prognosis. Presented at: AHA 2021; November 13-15, 2021. Poste:r P1979.


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