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Updated: Sep 10, 2025

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Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-analysis.

Ricky D Turgeon1, Blair J MacDonald1, Scott R Garrison2

  • 1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

The Canadian Journal of Cardiology
|August 21, 2025
PubMed
Summary

Administering blood pressure medications in the evening does not reduce cardiovascular events compared to morning dosing. This meta-analysis found no significant benefit for evening administration in hypertensive patients.

Keywords:
Bayesianantihypertensivebedtimehypertensionnocturnal

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The optimal timing for antihypertensive medication administration remains debated regarding cardiovascular event reduction.
  • Existing randomized evidence needs synthesis to clarify the benefits of evening versus morning dosing.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) comparing evening versus morning administration of antihypertensive medications.
  • To assess the impact of medication timing on major adverse cardiovascular events and other clinical outcomes.

Main Methods:

  • A comprehensive systematic search of MEDLINE, Embase, and CENTRAL databases was conducted.
  • Five RCTs involving 46,606 hypertensive adults with a median follow-up of 5.2 years were included.
  • Meta-analysis of trial-level data was performed using a random-effects model, with sensitivity analyses on low-risk-of-bias trials.

Main Results:

  • Evening administration of antihypertensive medications did not significantly reduce major adverse cardiovascular events compared to morning administration (HR, 0.71; 95% CI, 0.43-1.16).
  • Analysis restricted to low risk of bias trials also showed no significant difference (HR, 0.94; 95% CI, 0.86-1.03).
  • High heterogeneity (I2=94%) was observed in the overall analysis.

Conclusions:

  • Evening administration of antihypertensive medications does not offer a reduction in cardiovascular events compared to morning administration in adults with hypertension.
  • The findings suggest that current timing strategies for antihypertensive therapy may not influence major cardiovascular outcomes.