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Does Timing of Antihypertensive Medication Dosing Matter?

  • Hypertension (DS Geller and DL Cohen, Section Editors)
  • Published:
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Abstract

Purpose of Review

Current hypertension guidelines do not provide recommendation on when-to-treat. Herein, we review the current evidence on ingestion-time differences of hypertension medications in blood pressure (BP)–lowering effects and prevention of cardiovascular disease (CVD) events.

Recent Findings

The vast (81.6%) majority of the 136 published short-term treatment-time trials document benefits, including enhanced reduction of asleep BP and increased sleep-time relative BP decline (dipping), when hypertension medications and their combinations are ingested before sleep rather than upon waking. Long-term outcome trials further document bedtime hypertension therapy markedly reduces risk of major CVD events. The inability of the very small 18.4% of the published trials to substantiate treatment-time difference in effects is mostly explained by deficiencies of study design and conduct.

Summary

Our comprehensive review of the published literature reveals no single study has reported better benefits of the still conventional, yet scientifically unjustified, morning than bedtime hypertension treatment scheme.

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Authors and Affiliations

  1. Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic);, University of Vigo, 36310, Vigo, Spain

    Ramón C. Hermida, Artemio Mojón, Juan J. Crespo, María T. Ríos & José R. Fernández

  2. Department of Biomedical Engineering, Cockrell School of Engineering,, The University of Texas at Austin, Austin, TX, 78712-0238, USA

    Ramón C. Hermida & Michael H. Smolensky

  3. Circadian Ambulatory Technology & Diagnostics (CAT&D), 15703, Santiago de Compostela, Spain

    Ramón G. Hermida-Ayala

  4. Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), 36214, Vigo, Spain

    Juan J. Crespo, María T. Ríos & Manuel Domínguez-Sardiña

  5. Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), 32005, Ourense, Spain

    Alfonso Otero

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  1. Ramón C. Hermida
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  2. Ramón G. Hermida-Ayala
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  3. Michael H. Smolensky
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  4. Artemio Mojón
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  5. Juan J. Crespo
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  6. Alfonso Otero
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  7. María T. Ríos
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  8. Manuel Domínguez-Sardiña
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  9. José R. Fernández
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Correspondence to Ramón C. Hermida.

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Hermida, R.C., Hermida-Ayala, R.G., Smolensky, M.H. et al. Does Timing of Antihypertensive Medication Dosing Matter?. Curr Cardiol Rep 22, 118 (2020). https://doi.org/10.1007/s11886-020-01353-7

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