Controversies in hypertension therapy: bedtime dosing or daytime dosing?

Hypertension management strategies have evolved from solely controlling office blood pressure (BP) to comprehensive 24-h BP regulation. This review synthesizes current evidence on the timing of antihypertensive medication, with a focus on circadian BP rhythms and patients with specific BP patterns or comorbidities. Bedtime dosing may benefit individuals with nocturnal hypertension and nondipper BP patterns, but large trials, such as the TIME study, have shown no significant cardiovascular outcome differences between morning and bedtime dosing. However, the optimal timing of antihypertensive medication for patients with distinct BP rhythms or comorbidities remains uncertain. Future research should investigate the potential benefits of personalized medication timing tailored to BP patterns and clinical conditions. Additionally, treatment strategies should consider BP rhythms, comorbidities, and adherence to optimize outcomes, paving the way for more effective management of hypertensive patients with complex clinical profiles.