Taking blood pressure medication at bedtime did not reduce the risk of death or major cardiovascular events compared with morning dosing, according to the results of a large Canadian study.

The BedMed study followed 3,357 adults with hypertension over a median of 4.6 years. Participants were randomly assigned 1:1 o take all their once-daily blood pressure medications in the morning or at bedtime to determine whether timing affected the risk of stroke, heart attack, heart failure, or death.

The results showed no significant difference between the groups. The event rate was 2.3 per 100 patient-years for the bedtime group and 2.4 per 100 patient-years for the morning group.

Safety outcomes, including falls, fractures, cognitive decline, and new glaucoma diagnoses were also observed, with no differences being found, reported Scott R. Garrison, MD, University of Alberta, Edmonton, Canada, and colleagues.

Participants were recruited through 436 primary care providers across 5 Canadian provinces. The median age was 67 years, and 56% were women. Most were taking a single antihypertensive agent, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, or beta-blockers.

To assess effects on nocturnal blood pressure, a subgroup of 302 participants underwent 24-hour ambulatory monitoring. Nighttime blood pressure was lower in the bedtime group—by 7.4 mm Hg systolic and 2.7 mm Hg diastolic on average—but this did not translate into improved clinical outcomes.

Adherence was slightly higher in the morning group. At 6 months, 95% of morning group participants reported following the assigned timing versus 83% in the bedtime group. Adherence declined over time but remained relatively high.

The findings are consistent with a previous trial (TIME) that also reported no benefit from bedtime dosing, contrasting with earlier studies that suggested substantial reductions in cardiovascular events, noted Dr. Garrison and colleagues.

Their disclosures can be found in the published study.

Source: JAMA Network