Blood pressure lowering medications : take in the morning or in the evening?

At one of the sessions of the last Congress of the European Society of Cardiology (ESC Congress 2022), the results of a randomized trial involving more than 21,000 patients with high blood pressure, followed for more than five years, were made public. The results of the study showed no relationship between the protective function of the antihypertensive medications taken in relation to the development of myocardial infarction, stroke and cardiovascular death, depending on whether the drugs are taken in the morning or in the evening. This study contradicts previous analyzes that suggested a greater cardiovascular benefit from evening antihypertensive therapy.

According to statistics, more than one billion people worldwide have high blood pressure. High blood pressure is the leading global cause of premature death, accounting for nearly 10 million deaths in 2015, of which 4.9 million were due to coronary heart disease and 3.5 million to stroke.

This prospective randomized TIME study included a total of 21,104 patients who were randomized as follows: 10,503 patients received the evening dose of antihypertensive therapy and 10,601 the morning dose. The average age of the participants was 65 years, 58% male. The median follow-up was 5.2 years, but some of them were in the study for more than nine years.

Principal investigator Professor Thomas MacDonald of the University of Dundee, UK said: “TIME was one of the largest cardiovascular studies ever conducted and provides a definitive answer on the question of whether blood pressure lowering medications should be taken in the morning or evening. The trial clearly found that heart attack, stroke and vascular death occurred to a similar degree regardless of the time of administration. People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them and minimises any undesirable effects.”