Evening administration of BP-lowering medications had no clinical benefits over morning administration, according to research shared at the ESC Congress 2024 in London.

The BedMed trial in the general primary care population and the BedMed-Frail trial in nursing-home residents found that while evening dosing was safe, it conveyed no additional advantages. 

In the BedMed trial, Canadian primary care patients who were prescribed at least one once-daily antihypertensive medication were randomly assigned (1:1) to take all amenable antihypertensives either in the morning or at bedtime. 

The primary outcome was major adverse cardiovascular events (MACE), ie. all-cause death, hospitalisation/ED visit for stroke, MI/acute coronary syndrome or congestive HF. Secondary outcomes included all-cause unplanned hospitalisation/ED visits and visual, cognitive and fracture-related events. 

In the BedMed-Frail, residents of Canadian continuing care wards were assigned to either bedtime or morning dosing. Secondary outcomes included skin ulceration and deteriorated cognition. 

In the BedMed trial, 3,357 adults were randomised; over a median follow-up of 4.6 years, the primary outcome of MACE occurred in 9.7% of participants in the bedtime group and 10.3% in the morning group. There were no differences in safety outcomes and all-cause hospitalisation/ED visits and safety outcomes between the groups.

In the BedMed-Frail trial, the 776 participants had a median age of 88 years and 72% were female. Over a median of 415 days, the primary outcome of MACE occurred in 40.6% in the bedtime and 41.9% in the morning group. There was no difference in secondary efficacy and safety outcomes, except for all-cause unplanned hospitalisation/ED visits, which favoured bedtime use.

Bedtime vs morning use provided no difference in MACE, nor in potential safety events in a general population and in frail older patients.